Provider Demographics
NPI:1922168558
Name:NEPHROLOGY AND HYPERTENSION ASSOC PC
Entity Type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-758-1800
Mailing Address - Street 1:850 STRAITS TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2843
Mailing Address - Country:US
Mailing Address - Phone:203-758-1800
Mailing Address - Fax:203-758-1804
Practice Address - Street 1:850 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2843
Practice Address - Country:US
Practice Address - Phone:203-758-1800
Practice Address - Fax:203-758-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00985Medicare ID - Type Unspecified