| Doctor Name: | MR. BRIAN ROEDER |
| NPI Number: | 1023034170 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C |
| License Number: | C00624 |
| Business Practice Address: | 301 Hospital Dr Suite 803 Glen Burnie, MD - 210615803 |
| Business Phone Number: | 4105538160 |
| Business Fax Number: | 4105538159 |
| Mailing Address: | 301 Hospital Dr, Suite 803 GLEN BURNIE |
| State: | MD |
| Postal Code: | 210615803 |
| Phone Number: | 4105538160 |
| Fax Number: | 4105538159 |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | C00624 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |