Provider Demographics
NPI:1205559499
Name:EZEMMA, ROSITA ADAMMA
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:ADAMMA
Last Name:EZEMMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GOVERNORS CT APT D
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3198
Mailing Address - Country:US
Mailing Address - Phone:801-574-1728
Mailing Address - Fax:
Practice Address - Street 1:6323 GEORGIA AVE NW STE 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1141
Practice Address - Country:US
Practice Address - Phone:202-234-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator