Healthcare Provider Details

I. General information

NPI: 1710974480
Provider Name (Legal Business Name): ROGER A. POMPEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/27/2010
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 Number30135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: