Provider Demographics
NPI:1740216605
Name:KIERCE, ROGER PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PATRICK
Last Name:KIERCE
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 1:57 WILLOWBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7045
Mailing Address - Country:US
Mailing Address - Phone:973-754-4075
Mailing Address - Fax:973-256-6523
Practice Address - Street 1:57 WILLOWBROOK BLVD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7045
Practice Address - Country:US
Practice Address - Phone:973-754-4075
Practice Address - Fax:973-256-6523
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50014207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5231507Medicaid
NJ544938UY3Medicare ID - Type Unspecified
NJF37742Medicare UPIN