Healthcare Provider Details

I. General information

NPI: 1023976040
Provider Name (Legal Business Name): BLAIR MARIE ROHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 MD RT 3 N STE 202
GAMBRILLS MD
21054-1784
US

IV. Provider business mailing address

1071 MD RT 3 N STE 202
GAMBRILLS MD
21054-1784
US

V. Phone/Fax

Practice location:
  • Phone: 443-517-3330
  • Fax:
Mailing address:
  • Phone: 443-517-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR182566
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: