Provider Demographics
NPI:1922076421
Name:ALLCROFT, ROGER ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
Last Name:ALLCROFT
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 1:163 CONZ ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3848
Mailing Address - Country:US
Mailing Address - Phone:413-586-3200
Mailing Address - Fax:413-587-0970
Practice Address - Street 1:163 CONZ ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3848
Practice Address - Country:US
Practice Address - Phone:413-586-3200
Practice Address - Fax:413-587-0970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57595207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3677236OtherAETNA
MA3023222/9751271Medicaid
MA768864OtherTUFTS HEALTH PLANS
MAAA13479OtherHARVARD PILGRIM
MAJ06413/M18763OtherBC/BS INDIVIDUAL/GROUP
MA10131OtherHEALTH NEW ENGLAND
MA799543OtherCONNECTICARE
MA6668066OtherCIGNA
MAP00242595/DD6666OtherRR MEDICARE INDIVIDUAL/GR
MA6668066OtherCIGNA
MAA66456Medicare UPIN