Provider Demographics
NPI:1023083037
Name:FORDEN, ROGER A (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:FORDEN
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 1:341 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2819
Mailing Address - Country:US
Mailing Address - Phone:716-833-2333
Mailing Address - Fax:716-833-3972
Practice Address - Street 1:341 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2819
Practice Address - Country:US
Practice Address - Phone:716-833-2333
Practice Address - Fax:716-833-3972
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00609912Medicaid