Provider Demographics
NPI:1053870998
Name:ROLLER, CHRISTOPHER ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D RECON BN
Mailing Address - Street 2:UNIT 36180
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96389
Mailing Address - Country:US
Mailing Address - Phone:098-625-2486
Mailing Address - Fax:
Practice Address - Street 1:3D RECON BN
Practice Address - Street 2:UNIT 36180
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96389
Practice Address - Country:US
Practice Address - Phone:098-625-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270330208D00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice