Provider Demographics
NPI:1669669313
Name:WERNER, ROLAND EDMUND (RCIS)
Entity type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:EDMUND
Last Name:WERNER
Suffix:
Gender:M
Credentials:RCIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8511
Mailing Address - Country:US
Mailing Address - Phone:585-967-7767
Mailing Address - Fax:
Practice Address - Street 1:100 W COMMONS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2419
Practice Address - Country:US
Practice Address - Phone:302-709-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00052458246XC2901X
DEL1-0049676367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist