Provider Demographics
NPI:1063497865
Name:BARRETTE, ROGER ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ROBERT
Last Name:BARRETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 BREEZEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-8557
Mailing Address - Country:US
Mailing Address - Phone:412-335-9557
Mailing Address - Fax:
Practice Address - Street 1:1033 BREEZEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:412-335-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026941E208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2007428000Medicaid
OH626040Medicaid
NY03196774Medicaid
PA0011418810007Medicaid
PA192735NDXMedicare PIN
NY03196774Medicaid