Provider Demographics
NPI:1831113919
Name:ROESER, MICHELLE M (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:ROESER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8314 TRAFORD LN
Mailing Address - Street 2:C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1651
Mailing Address - Country:US
Mailing Address - Phone:703-644-7804
Mailing Address - Fax:703-644-1508
Practice Address - Street 1:8314 TRAFORD LN
Practice Address - Street 2:C
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1651
Practice Address - Country:US
Practice Address - Phone:703-644-7804
Practice Address - Fax:703-644-1508
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN48747207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I56230Medicare UPIN
MN298668100Medicaid
I56230Medicare UPIN