Basic Information
Provider Information
NPI: 1770817751
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROHLEDER
FirstName: CLAIRE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20010 CENTURY BLVD
Address2: SUITE 200
City: GERMANTOWN
State: MD
PostalCode: 208741115
CountryCode: US
TelephoneNumber: 2406862300
FaxNumber: 2406862330
Practice Location
Address1: 20010 CENTURY BLVD
Address2: SUITE 200
City: GERMANTOWN
State: MD
PostalCode: 208741115
CountryCode: US
TelephoneNumber: 2406862300
FaxNumber: 2406862330
Other Information
ProviderEnumerationDate: 09/24/2009
LastUpdateDate: 09/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X0110003151VAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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