Healthcare Provider Details

I. General information

NPI: 1720909096
Provider Name (Legal Business Name): ROGER P. INBODEN BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 E VIEW LN STE 3
BARRE VT
05641-5332
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-301-3381
  • Fax: 802-735-2372
Mailing address:
  • Phone: 802-229-1399
  • Fax: 802-223-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0137018
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: