Healthcare Provider Details

I. General information

NPI: 1417904343
Provider Name (Legal Business Name): ROGER B NOWAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGH ST STE 301
HAMPTON NH
03842-2213
US

IV. Provider business mailing address

55 HIGH ST STE 301
HAMPTON NH
03842-2213
US

V. Phone/Fax

Practice location:
  • Phone: 603-770-2633
  • Fax:
Mailing address:
  • Phone: 603-967-8033
  • Fax: 603-601-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10688
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number10688
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: