Provider Demographics
NPI:1932429719
Name:NJOH, ROLAND FOKWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:FOKWEN
Last Name:NJOH
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 1:56 FRANKLIN ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-3800
Mailing Address - Fax:203-709-5122
Practice Address - Street 1:3100 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1573
Practice Address - Country:US
Practice Address - Phone:573-776-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51815207R00000X
MO2018017509207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT05291835OtherAETNA
CT010051815CT1OtherANTHEM BCBS CT
CT912982OtherWELLCARE
CT051815OtherCONNECTICARE
CTP01268780OtherRR MEDICARE
CT02488510OtherCOVENTRY/FIRST HEATLH
CT912982OtherWELLCARE