Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9680 | MD |
NPI | 1134204480 |
---|---|
Provider Name | James Olin Roahen |
First Address | Annapolis, MD 21409-6213 |
Second Address | Annapolis, MD 21401-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |