Provider Demographics
NPI:1700188174
Name:EDWARD G. ROHALY,M.D. INC.
Entity Type:Organization
Organization Name:EDWARD G. ROHALY,M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ROHALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-640-0434
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7829
Mailing Address - Country:US
Mailing Address - Phone:949-640-0434
Mailing Address - Fax:949-640-0277
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7829
Practice Address - Country:US
Practice Address - Phone:949-640-0434
Practice Address - Fax:949-640-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62009261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54404Medicare UPIN