Provider Demographics
NPI:1538355789
Name:GREYSON-FLEG, ROSEMARIE T (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:T
Last Name:GREYSON-FLEG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 MALLARD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3180
Mailing Address - Country:US
Mailing Address - Phone:301-776-4777
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3180
Practice Address - Country:US
Practice Address - Phone:301-776-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00297612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70561Medicare UPIN
RG00A514L51Medicare PIN