Individual
JUSTIN THEODORE ROSCOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
180 ADMIRAL COCHRANE DR STE 410&420, ANNAPOLIS, MD 21401-7300
(443) 351-3376
Mailing address
1306 CONCOURSE DR STE 201, LINTHICUM HEIGHTS, MD 21090-1033
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0036008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2105110 00
—
MD
Enumeration date
03/08/2006
Last updated
04/13/2022
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