Basic Information
Provider Information
NPI: 1063733616
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RO
FirstName: RICHARD
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 MELVIN AVE
Address2: SUITE 7A
City: ANNAPOLIS
State: MD
PostalCode: 214011514
CountryCode: US
TelephoneNumber: 4102802260
FaxNumber:  
Practice Location
Address1: 2001 MEDICAL PKWY
Address2:  
City: ANNAPOLIS
State: MD
PostalCode: 214013773
CountryCode: US
TelephoneNumber: 4102802260
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/17/2010
LastUpdateDate: 08/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XD0079695MDY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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