MEDICARE: DR. JULIUS PETER ROLL 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	207W00000X	Ophthalmology Physician	MD040171E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568519197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIUS PETER ROLL M.D.

Provider Business Mailing Address
First Line	:	2602 DOGWOOD CT
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1719
Country	:	US
Telephone Number	:	412-672-3383
Fax Number	:	724-935-7156

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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