Provider Demographics
NPI:1861488611
Name:OLDHAM, ROGER J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:OLDHAM
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 1:10215 FERNWOOD RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-530-6100
Mailing Address - Fax:301-530-6104
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 412
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-530-6100
Practice Address - Fax:301-530-6104
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2008-03-03
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100979Medicare PIN
MDB93367Medicare UPIN