Provider Demographics
NPI:1922408608
Name:SAGE INTEGRATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:SAGE INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROEMMELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-583-4780
Mailing Address - Street 1:157 PORTSMOUTH AVE
Mailing Address - Street 2:UNIT 13
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2477
Mailing Address - Country:US
Mailing Address - Phone:603-583-4780
Mailing Address - Fax:603-821-0273
Practice Address - Street 1:157 PORTSMOUTH AVE
Practice Address - Street 2:UNIT 13
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2477
Practice Address - Country:US
Practice Address - Phone:603-583-4780
Practice Address - Fax:603-821-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11640207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty