Provider Demographics
NPI:1205865136
Name:ROUHANI, JAHANGIR (MD)
Entity type:Individual
Prefix:
First Name:JAHANGIR
Middle Name:
Last Name:ROUHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ROUHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:7601 OSLER DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7700
Practice Address - Country:US
Practice Address - Phone:410-337-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCD64168174400000X
PAMD433353208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2022416OtherHIGHMARK BLUE SHIELD
PA9180189OtherAETNA
PA102098859Medicaid
PA118473OtherGEISINGER HEALTH PLAN
MD410781100Medicaid
MD410781101Medicaid
PA50078627OtherCAPITAL BLUE CROSS-WMG
MD885640-01OtherCAREFIRST MD BCBS
PA1571818OtherGATEWAY-WMG
PA9180189OtherAETNA