Provider Demographics
NPI:1619134475
Name:ROHANI, PEJMAN (DO)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:ROHANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 W COUGAR BLVD STE 503
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3323
Practice Address - Country:US
Practice Address - Phone:801-374-9100
Practice Address - Fax:801-374-9117
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB089400002086S0102X, 2086S0129X
NDLT188912086S0129X
UT12841173-12042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0348899OtherGROUP MEDICAID
216927OtherGROUP MEDICARE
216927OtherGROUP MEDICARE
242845YEM4Medicare PIN