Provider Demographics
NPI:1588797518
Name:ROEDELL, SAMUEL T (BA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:ROEDELL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-2032
Mailing Address - Country:US
Mailing Address - Phone:603-228-2101
Mailing Address - Fax:
Practice Address - Street 1:30 BOROUGH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PENACOOK
Practice Address - State:NH
Practice Address - Zip Code:03303-1918
Practice Address - Country:US
Practice Address - Phone:603-228-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator