=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215266945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE N ROHE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2009
-----------------------------------------------------
Last Update Date | 05/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N 17TH ST STE 307
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-5034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-434-2162
-----------------------------------------------------
Fax | 610-434-9370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 N 17TH ST STE 307 STE 307
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-5051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-434-2162
-----------------------------------------------------
Fax | 610-434-9370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA054224
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------