Healthcare Provider Details

I. General information

NPI: 1518981182
Provider Name (Legal Business Name): ROGER A OWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIDGEWOOD RD THE PEDIATRIC NETWORK
SPRINGFIELD VT
05156-3050
US

IV. Provider business mailing address

PO BOX 2003 THE PEDIATRIC NETWORK
SPRINGFIELD VT
05156-2003
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-5716
  • Fax:
Mailing address:
  • Phone: 802-885-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0005683
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: