Provider Demographics
NPI:1952406308
Name:KNAUSENBERGER, ROLAND H (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:H
Last Name:KNAUSENBERGER
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 1:174 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5134
Mailing Address - Country:US
Mailing Address - Phone:800-395-0232
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:180 KENNEDY MEMORIAL DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-2900
Practice Address - Fax:207-872-8495
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME01428207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131920099Medicaid
ME099282OtherANTHEM
ME131920099Medicaid
MEMM7555Medicare PIN