Healthcare Provider Details

I. General information

NPI: 1417272279
Provider Name (Legal Business Name): RODWELL MABAERA M.D., PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - HEMATOLOGY/ONCOLOGY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - HEMATOLOGY/ONCOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-2967
  • Fax:
Mailing address:
  • Phone: 603-650-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number16078
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: