Basic Information
| Provider Information | |||||||||
| NPI: | 1205865136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUHANI | ||||||||
| FirstName: | JAHANGIR | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ROUHANI | ||||||||
| OtherFirstName: | JOHN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 OSLER DR | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103371150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D64168 | NC | N | Other Service Providers | Specialist | 208000000X | MD433353 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | MD433353 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2022416 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 885640-01 | 01 | MD | CAREFIRST MD BCBS | OTHER | 410781101 | 05 | MD | MEDICAID | 1571818 | 01 | PA | GATEWAY-WMG | OTHER | 410781100 | 05 | MD | MEDICAID | 102098859 | 05 | PA | MEDICAID | 118473 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 50078627 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 9180189 | 01 | PA | AETNA | OTHER |