1205865136 NPI number — JAHANGIR ROUHANI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205865136 NPI number — JAHANGIR ROUHANI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ROUHANI

Provider First Name:

JAHANGIR

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

ROUHANI

Provider Other First Name:

JOHN

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

5

NPI Number:

1205865136

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/20/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1803 MOUNT ROSE AVE

Provider Second Line Business Mailing Address:

SUITE B3

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17403-3026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-1405

Provider Business Mailing Address Fax Number:

717-851-6969

Provider First Line Business Practice Location Address:

7601 OSLER DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TOWSON

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21204-7700

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-337-1150

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  D64168 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: MD433353 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080N0001X , with the licence number: MD433353 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2022416 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 9180189 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 102098859 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 118473 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 410781100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 410781101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 50078627 . This is a "CAPITAL BLUE CROSS-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 885640-01 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1571818 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".