Provider Demographics
NPI:1255590048
Name:TRAUB, ROGER DENNIS (MD)
Entity type:Individual
Prefix:PROF
First Name:ROGER
Middle Name:DENNIS
Last Name:TRAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:SUNY DOWNSTATE MEDICAL CENTER, BOX 31
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-6762
Mailing Address - Fax:718-270-8242
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUNY DOWNSTATE MEDICAL CENTER, BOX 31
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-6762
Practice Address - Fax:718-270-8242
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124452-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology