Healthcare Provider Details

I. General information

NPI: 1861424020
Provider Name (Legal Business Name): DAVID ROLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 AZALEA CT
BARNEGAT NJ
08005-2049
US

IV. Provider business mailing address

26 AZALEA CT
BARNEGAT NJ
08005-2049
US

V. Phone/Fax

Practice location:
  • Phone: 609-698-2189
  • Fax:
Mailing address:
  • Phone: 609-698-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA04503600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: