Provider Demographics
NPI:1710900287
Name:AUSTIN, ROGER N (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:N
Last Name:AUSTIN
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 1:15 STRAWBERRY AVE
Mailing Address - Street 2:PO BOX 819
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5941
Mailing Address - Country:US
Mailing Address - Phone:207-777-7740
Mailing Address - Fax:207-777-7748
Practice Address - Street 1:236 STETSON RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6422
Practice Address - Country:US
Practice Address - Phone:207-333-6300
Practice Address - Fax:207-333-6309
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009609207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME256640099Medicaid
ME079009OtherANTHEM
ME256640099Medicaid
ME004844Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE