Provider Demographics
NPI:1578571394
Name:PRYZANT, RODGER M (MD)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:M
Last Name:PRYZANT
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 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH249202085R0001X
MEMD133082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF28638Medicare UPIN
MEM62171OtherCIGNA
NH30010416Medicaid
ME0005790468OtherAETNA/USHC
MEF28638OtherHPHC
MEMM4312Medicare ID - Type Unspecified
ME026378OtherANTHEM
ME2323485OtherAETNA
ME315740099Medicaid
ME920002292Medicare ID - Type UnspecifiedRAILROAD