Basic Information
| Provider Information | |||||||||
| NPI: | 1689612509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATEO | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7651 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216018141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103106245 | ||||||||
| FaxNumber: | 4108229683 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434770949 | ||||||||
| FaxNumber: | 4108229683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 09/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | D0064147 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | P00353286 | 01 | MD | PALMETTO GBA/RAILROAD MEDICARE | OTHER | 409993100 | 05 | MD | MEDICAID | 88675501 | 01 | MD | CAREFIRST BS | OTHER | E6360012 | 01 | MD | FEDERAL BS | OTHER | 208476 | 01 | MD | PRIORITY PARTNERS | OTHER |