Provider Demographics
NPI:1801850862
Name:EVANS, ROGER ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ANTHONY
Last Name:EVANS
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 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3131
Mailing Address - Country:US
Mailing Address - Phone:603-868-2451
Mailing Address - Fax:
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2833
Practice Address - Country:US
Practice Address - Phone:603-742-5011
Practice Address - Fax:603-742-3530
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001213Medicaid
NHD03651OtherHARVARD PILGRIM
NH0104451Y0NH01OtherBC/BS
NH4481234OtherAETNA
NH0444703OtherCIGNA
NH34445100OtherMARTINS POINT
NH0104451Y0NH01OtherBC/BS
NHD03651OtherHARVARD PILGRIM
NHD03651Medicare UPIN