Provider Demographics
NPI:1669462354
Name:FRIEDEN, ROGER S (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:FRIEDEN
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 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8300
Mailing Address - Fax:603-663-8349
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8300
Practice Address - Fax:603-663-8349
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2192432OtherAETNA PIN
NHP674376OtherOXFORD
NH12-40727OtherUHC PIN
NH406446OtherTUFTS
NH20024YOtherANTHEM REFERRING RAN
NHHLO030OtherHPHC
NH0102584YPNH01OtherANTHEM ACES PIN
NH2123OtherCIGNA PIN
NH30003025Medicare ID - Type UnspecifiedMEDICAID PIN
NH20024YOtherANTHEM REFERRING RAN
NH0102584YPNH01OtherANTHEM ACES PIN