MEDICARE: ROGER THEODORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	D0014165	MD

General Provider Information

NPI Number	:	1306841614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER THEODORE M.D.

Provider Business Mailing Address
First Line	:	1001 CROMWELL BRIDGE RD
Second Line	:	SUITE 200
City	:	TOWSON
State	:	MD
Zip	:	21286-3300
Country	:	US
Telephone Number	:	410-821-7775
Fax Number	:	410-821-1320

Provider Business Practice Location Address
First Line	:	1001 CROMWELL BRIDGE RD
Second Line	:	SUITE 200
City	:	TOWSON
State	:	MD
Zip	:	21286-3300
Country	:	US
Telephone Number	:	410-821-7775
Fax Number	:	410-821-1320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/28/2016

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