Individual
KEITH A ROLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8401 MARKET ST, BOARDMAN, OH 44512-6725
(330) 286-5330
(330) 286-5396
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
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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