Provider Demographics
NPI:1144290347
Name:ROHAN, JAMES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:ROHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:HORNIG-ROHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:290 W SIDE RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:ME
Mailing Address - Zip Code:04606-3022
Mailing Address - Country:US
Mailing Address - Phone:207-483-4091
Mailing Address - Fax:207-483-4091
Practice Address - Street 1:290 W SIDE RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:ME
Practice Address - Zip Code:04606-3022
Practice Address - Country:US
Practice Address - Phone:207-483-4091
Practice Address - Fax:207-483-4091
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT563999912052085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD5921Medicaid
UT563999912000OtherBLUE CROSS OF UT
UTD5921Medicaid
H38512Medicare UPIN