Provider Demographics
NPI:1831137405
Name:INHORN, ROGER C (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:INHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-553-6868
Mailing Address - Fax:207-553-6899
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6868
Practice Address - Fax:207-553-6899
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME016624207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME422150099Medicaid
MEME0846Medicare ID - Type Unspecified
MEF29906Medicare UPIN
MEUX3934Medicare PIN