Provider Demographics
NPI:1255355764
Name:ALDER, ROMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:ALDER
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 1:41 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3507
Mailing Address - Country:US
Mailing Address - Phone:860-355-4113
Mailing Address - Fax:860-350-4271
Practice Address - Street 1:41 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3507
Practice Address - Country:US
Practice Address - Phone:860-355-4113
Practice Address - Fax:860-350-4271
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics