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NPI Code Detail

MEDICARE: SAMANTHA ROHE M.D.

MEDICARE: SAMANTHA ROHE 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
1390200000XStudent in an Organized Health Care Education/Training ProgramMO
2208000000XPediatrics Physician2017008373MO

General Provider Information

NPI Number : 1568881746
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ROHE M.D.
Provider Business Mailing Address
First Line : 423 N 40TH ST APT 6
Second Line :
City : OMAHA
State : NE
Zip : 68131-2346
Country : US
Telephone Number : 712-301-3479
Fax Number :
Provider Business Practice Location Address
First Line : 1465 S GRAND BLVD RM 2717
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1003
Country : US
Telephone Number : 314-577-5634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 06/02/2017

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