Individual
JOSEPH L DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
698 BALTIMORE PIKE, BEL AIR, MD 21014-4264
(410) 879-0044
(410) 893-6871
Mailing address
920 PROVIDENCE RD, STE 100, TOWSON, MD 21286-2976
(703) 847-8899
(709) 866-7954
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0948
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161268900
—
MD
01
—
KZ41 / 687259-01
BC / BS OF MD
MD
01
—
S186 / 0029
BLUECHOICE
MD
Enumeration date
06/14/2006
Last updated
08/06/2020
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