Provider Demographics
NPI:1790059889
Name:ROGER M OLANDER MD PC
Entity Type:Organization
Organization Name:ROGER M OLANDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:OLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-244-2084
Mailing Address - Street 1:990 SOUTH AVE STE 104A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2740
Mailing Address - Country:US
Mailing Address - Phone:585-244-2084
Mailing Address - Fax:
Practice Address - Street 1:990 SOUTH AVE STE 104A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2740
Practice Address - Country:US
Practice Address - Phone:585-244-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16817BOtherMEDICARE GROUP NPI
16817BOtherMEDICARE GROUP NPI