Healthcare Provider Details

I. General information

NPI: 1184251464
Provider Name (Legal Business Name): ROGER JOHN MARTINKUS JR. PMHNP-BC, MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 JUNCTION SQUARE DR
CONCORD MA
01742-3049
US

IV. Provider business mailing address

3 ANDREWS CIR
BEDFORD MA
01731-2601
US

V. Phone/Fax

Practice location:
  • Phone: 205-422-8262
  • Fax:
Mailing address:
  • Phone: 205-422-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN2330678
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number083215-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: