Provider Demographics
NPI:1285756767
Name:ROEMBKE, JAMES E JR (PSYD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:ROEMBKE
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RECORD ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5418
Mailing Address - Country:US
Mailing Address - Phone:301-620-8700
Mailing Address - Fax:301-620-8710
Practice Address - Street 1:116 RECORD ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5418
Practice Address - Country:US
Practice Address - Phone:301-620-8700
Practice Address - Fax:301-620-8710
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03421103T00000X, 103TC0700X, 103TC2200X, 103TF0000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD049N895FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER