MEDICARE: JOHN H ROEDIGER 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	207Y00000X	Otolaryngology Physician	MD8727	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B86271	OTHER	ME	HARVARD PILGRIM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1044199	OTHER	ME	AETNA
4	040512	OTHER	ME	ANTHEM

General Provider Information

NPI Number	:	1881682789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H ROEDIGER M.D

Provider Business Mailing Address
First Line	:	301C US ROUTE 1
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9701
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	1250 FOREST AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1897
Country	:	US
Telephone Number	:	207-797-5753
Fax Number	:	207-797-9571

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	04/03/2012

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