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General NPI Number Information
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NPI Number | 1366471559
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Entity Type | Individual
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Provider Name | ROGER MENDES MARQUES DPM
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Gender | Male
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 12 PENNS TRAIL SUITE 154
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City | NEWTOWN
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State | PA
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Zip | 18940-3438
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Country | US
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Telephone | 215-675-3005
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Fax | 888-662-0859
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Provider Business Mailing Address
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Address Line | 888 WORCESTER ST SUITE 130
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City | WELLESLEY
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State | MA
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Zip | 02482-3744
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Country | US
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Telephone | 617-964-6681
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Fax | 339-686-2561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC005633
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License Number State | PA
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