Provider Demographics
NPI:1033174255
Name:ROLERSON, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:ROLERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:13 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1804
Practice Address - Country:US
Practice Address - Phone:207-283-8800
Practice Address - Fax:207-286-9853
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME013679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1962858005OtherCIGNA
ME016584OtherANTHEM
MEF85121OtherHARVARD PILGRIM
ME245030099Medicaid
ME2939348OtherAETNA
MEF85121OtherHARVARD PILGRIM
F85121Medicare UPIN
ME245030099Medicaid