Provider Demographics
NPI:1710974480
Name:POMPEO, ROGER A (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:POMPEO
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 1:20 PARKINGWAY
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1700
Mailing Address - Country:US
Mailing Address - Phone:781-383-9422
Mailing Address - Fax:781-383-8024
Practice Address - Street 1:20 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1700
Practice Address - Country:US
Practice Address - Phone:781-383-9422
Practice Address - Fax:781-383-8024
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7170OtherHARVARD PILGRIM
MAC06014OtherBLUE CROSS
MA3192989Medicaid
MA706228OtherTUFTS
MA3192989Medicaid
MAC06014OtherBLUE CROSS