Provider Demographics
NPI:1689251142
Name:ROSE BOSEMAN, TIFFANY ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ELAINE
Last Name:ROSE BOSEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:ELAINE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:1647 WOODBROOKE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-8502
Practice Address - Country:US
Practice Address - Phone:410-546-2424
Practice Address - Fax:410-742-6633
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0103819207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid