Individual provider Active NPI

Amanda Nicole Roesch

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1639408701
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R175173 Issued in MD
Practice address
408 W Lombard St
Baltimore, MD 21201-1601
Phone
(667) 214-1899
NPI assigned
Dec 18, 2009
Last updated
Oct 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R175173 MD Primary

Addresses

Primary practice location

408 W Lombard St
Baltimore, MD 21201-1601

Mailing address

408 W Lombard St
Baltimore, MD 21201-1601
Phone (667) 214-1899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190522000794 MD Practitioner - Nurse Practitioner 9931234382 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Family Medicine Associates, P.a. Current Accepting new patients
University of Maryland Family Medicine Associates, P.a. CurrentSince Jun 3, 2019 Accepting new patients
University of Maryland Family Medicine Associates, P.a. CurrentSince Jun 3, 2019 Accepting new patients
University of Maryland Faculty Physicians Immediate Care, LLC CurrentSince Jun 3, 2019 Accepting new patients

Locations

408 W Lombard St
Baltimore, MD 21201
Phone (667) 214-1899

5890 Waterloo Rd
Columbia, MD 21045
Phone (410) 328-2603

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1639408701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 W LOMBARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011601",
            "telephone_number": "667-214-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W LOMBARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011601",
            "telephone_number": "667-214-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROESCH",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-18",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R175173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.