Healthcare Provider Details

I. General information

NPI: 1376573501
Provider Name (Legal Business Name): ROGER A. POMPEO, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARKINGWAY
COHASSET MA
02025-1700
US

IV. Provider business mailing address

20 PARKINGWAY
COHASSET MA
02025-1700
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-9422
  • Fax: 781-383-8024
Mailing address:
  • Phone: 781-383-9422
  • Fax: 781-383-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER A. POMPEO
Title or Position: MD
Credential: MD
Phone: 781-383-9422