Provider Demographics
NPI:1235211194
Name:ROHAN, MARY KATE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATE
Last Name:ROHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W LA PALMA AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2806
Mailing Address - Country:US
Mailing Address - Phone:714-284-4912
Mailing Address - Fax:714-284-4819
Practice Address - Street 1:1211 W LA PALMA AVE STE 407
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2806
Practice Address - Country:US
Practice Address - Phone:714-284-4912
Practice Address - Fax:714-284-4819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF86535Medicare UPIN
CAG73700BMedicare ID - Type Unspecified