Active NPI
Rosetta Randolph
- Prosthetist
- Baltimore, MD
National Provider Identifier
1447866074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- 82332
- Practice address
- 15 Wytchwood CT Apt T1
Baltimore, MD 21209-4832 - Phone
- (410) 622-7945
- NPI assigned
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | 82332 | MD | Primary |
Addresses
Primary practice location
15 Wytchwood CT Apt T1
Baltimore, MD 21209-4832
Mailing address
15 Wytchwood CT Apt T1
Baltimore, MD 21209-4832
Phone (410) 622-7945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82332 | MD | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1447866074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 WYTCHWOOD CT APT T1",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212094832",
"telephone_number": "410-622-7945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 WYTCHWOOD CT APT T1",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212094832",
"telephone_number": "410-622-7945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "ROSETTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-18",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "MD",
"license": "82332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.