Healthcare Provider Details

I. General information

NPI: 1922076421
Provider Name (Legal Business Name): ROGER ALLEN ALLCROFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 CONZ ST
NORTHAMPTON MA
01060-3848
US

IV. Provider business mailing address

163 CONZ ST
NORTHAMPTON MA
01060-3848
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-3200
  • Fax: 413-587-0970
Mailing address:
  • Phone: 413-586-3200
  • Fax: 413-587-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number57595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: