Provider Demographics
NPI:1063489839
Name:OLANDER, ROGER M (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:OLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SOUTH AVE
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-244-2084
Mailing Address - Fax:
Practice Address - Street 1:990 SOUTH AVE
Practice Address - Street 2:SUITE 104A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-244-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
102294CKOtherPREFERRED CARE
5983343OtherAETNA
10459448OtherCAQH
6094OtherBLUE SHIELD
NY00484299Medicaid
NYP010134145OtherBLUE CHOICE
NY16817BMedicare ID - Type Unspecified