Individual provider Active NPI

Roxanne Hughes-Wheatland, PHD

  • Clinical Neuropsychologist
  • Ellicott City, MD
National Provider Identifier
1952420820
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
02723 Issued in MD
Practice address
3355 Saint Johns LN Ste F
Ellicott City, MD 21042-2600
Phone
(443) 472-2923
Fax
(410) 480-0110
NPI assigned
Mar 29, 2007
Last updated
Oct 1, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 02723 MD Primary

Addresses

Primary practice location

3355 Saint Johns LN Ste F
Ellicott City, MD 21042-2600

Mailing address

3355 Saint Johns LN Ste F
Ellicott City, MD 21042-2600
Phone (443) 472-2923

Other practice location 1

707 N Broadway
Baltimore, MD 21205-1832
Phone (443) 923-1886

Other identifiers 1

IdentifierTypeStateIssuer
129001100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 1, 2018 through Jan 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
02723MDMDClinical Neuropsychologist

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1952420820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 SAINT JOHNS LN STE F",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422600",
            "telephone_number": "443-472-2923",
            "fax_number": "410-480-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 SAINT JOHNS LN STE F",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422600",
            "telephone_number": "443-472-2923",
            "fax_number": "410-480-0110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212051832",
            "country_code": "US",
            "telephone_number": "443-923-1886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUGHES-WHEATLAND",
        "first_name": "ROXANNE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MD",
            "license": "02723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129001100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.