Provider Demographics
NPI:1245258599
Name:ROHR-KIRCHGRABER, THERESA M (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:ROHR-KIRCHGRABER
Suffix:
Gender:F
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:1500 OGLETHORPE AVE STE 200C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2165
Practice Address - Country:US
Practice Address - Phone:706-389-3875
Practice Address - Fax:706-389-3876
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010643282080A0000X, 2080A0000X
GA54031207RA0000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200872680Medicaid
IN715530BZZZMedicare PIN
INF27498Medicare UPIN
IN210880CMedicare PIN
INM400034657Medicare PIN