Provider Demographics
NPI:1366471559
Name:MARQUES, ROGER MENDES (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:MENDES
Last Name:MARQUES
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:12 PENNS TRAIL
Practice Address - Street 2:SUITE 154
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3438
Practice Address - Country:US
Practice Address - Phone:215-675-3005
Practice Address - Fax:888-662-0859
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASC005633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019062040005Medicaid
PA2046669000OtherKEYSTONE HEALTH PLAN EAST
PA1354313OtherHIGHMARK BLUE SHIELD
PA480033946OtherMEDICARE RAILROAD
PAU81933Medicare UPIN
PA2046669000OtherKEYSTONE HEALTH PLAN EAST