Provider Demographics
NPI:1801891866
Name:ROESSLER, JAMES LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LLOYD
Last Name:ROESSLER
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:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-0020
Mailing Address - Country:US
Mailing Address - Phone:301-371-9000
Mailing Address - Fax:301-371-8905
Practice Address - Street 1:300 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8043
Practice Address - Country:US
Practice Address - Phone:301-371-9000
Practice Address - Fax:301-371-8905
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0100073OtherUNITED HEALTHCARE #
MD010038097OtherMEDICARE RAILROAD
MD4141245OtherAETNA #
MD814439OtherMDIPA #
MD309851600Medicaid
MD41996801OtherBCBS MD #
MD521189978OtherCIGNA #
MDH9310003OtherBCBS NCA #
MD010038097OtherMEDICARE RAILROAD
MDH9310003OtherBCBS NCA #
MD41996801OtherBCBS MD #