Provider Demographics
NPI:1558367334
Name:ROH, IHN WHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IHN
Middle Name:WHAN
Last Name:ROH
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 1:5107 SILVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5213
Mailing Address - Country:US
Mailing Address - Phone:301-568-1784
Mailing Address - Fax:301-899-8250
Practice Address - Street 1:5107 SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-5213
Practice Address - Country:US
Practice Address - Phone:301-568-1784
Practice Address - Fax:301-899-8250
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27449OtherPRIORITY PARTNERS
MD973071100Medicaid
MD01034225OtherAMERIGROUP OF MARYLAND COMMUNITY CARE
MD27449OtherPRIORITY PARTNERS
C62194Medicare UPIN