Provider Demographics
NPI:1679515282
Name:ROHOLT, PHILIP C (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:C
Last Name:ROHOLT
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 1:5890 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1547
Mailing Address - Country:US
Mailing Address - Phone:330-305-2200
Mailing Address - Fax:330-305-3310
Practice Address - Street 1:5890 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1547
Practice Address - Country:US
Practice Address - Phone:330-305-2200
Practice Address - Fax:330-305-3310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45634207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2987047004OtherCIGNA
1991085OtherUNITED HEALTH CARE
4087720OtherAETNA
000000203492OtherANTHEM
OH0558856Medicaid
OHA81301Medicare UPIN
OH0796302Medicare ID - Type Unspecified