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Individual

MR. BRIAN ROEDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.-C

Contact information

Practice address
301 HOSPITAL DR, SUITE 803, GLEN BURNIE, MD 21061-5803
(410) 553-8160
(410) 553-8159
Mailing address
301 HOSPITAL DR, SUITE 803, GLEN BURNIE, MD 21061-5803
(410) 553-8160
(410) 553-8159

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C00624
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
236285
KAISER PERM
MD
01
75551
AMERIGROUP
MD
Enumeration date
07/14/2006
Last updated
11/09/2015
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