Individual
KEITH A ROLLER
Active
Individual
KEITH A ROLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35058177
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000811586
ANTHEM BCBS
OH
05
—
1028247410001
—
PA
01
—
10896526
CAQH
—
05
—
2600242
—
OH
01
—
H011682
MEDICARE PTAN
OH
01
—
P01200681
MEDICARE RAILROAD
OH
Enumeration date
06/16/2006
Last updated
05/03/2016
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