Basic Information
| Provider Information | |||||||||
| NPI: | 1790848463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLAND | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103239210 | ||||||||
| FaxNumber: | 4103239525 | ||||||||
| Practice Location | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103239210 | ||||||||
| FaxNumber: | 4103239525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2006 | ||||||||
| LastUpdateDate: | 01/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD034910 | DC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35089496 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D0062094 | MD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.