Provider Demographics
NPI:1467204263
Name:ROHANI SURGICAL LLC
Entity type:Organization
Organization Name:ROHANI SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-742-2368
Mailing Address - Street 1:106 E RIDGEVILLE BLVD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5248
Mailing Address - Country:US
Mailing Address - Phone:240-732-1200
Mailing Address - Fax:877-940-4014
Practice Address - Street 1:106 E RIDGEVILLE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5248
Practice Address - Country:US
Practice Address - Phone:240-732-1200
Practice Address - Fax:877-940-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0097426OtherMEDICAL LICENSE NUMBER