Healthcare Provider Details

I. General information

NPI: 1063497865
Provider Name (Legal Business Name): ROGER ROBERT BARRETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 BREEZEWOOD DRIVE
CANONSBURG PA
15317
US

IV. Provider business mailing address

1033 BREEZEWOOD DR
CANONSBURG PA
15317-8557
US

V. Phone/Fax

Practice location:
  • Phone: 412-335-9557
  • Fax:
Mailing address:
  • Phone: 412-335-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD026941E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD026941E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: