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NPI Code Detail

MEDICARE: ROGER B NOWAK MD

MEDICARE: ROGER B NOWAK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician10688NH
2207X00000XOrthopaedic Surgery Physician10688NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417904343
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER B NOWAK MD
Provider Business Mailing Address
First Line : 55 HIGH ST STE 301
Second Line :
City : HAMPTON
State : NH
Zip : 03842-2213
Country : US
Telephone Number : 603-967-8033
Fax Number : 603-601-6040
Provider Business Practice Location Address
First Line : 55 HIGH ST STE 301
Second Line :
City : HAMPTON
State : NH
Zip : 03842-2213
Country : US
Telephone Number : 603-770-2633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 02/04/2021

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