Provider Demographics
NPI:1447295142
Name:TEMPLE, ROGER (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:TEMPLE
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 1:17 OLD ROLLINSFORD RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2833
Mailing Address - Country:US
Mailing Address - Phone:603-742-9222
Mailing Address - Fax:603-742-9226
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2833
Practice Address - Country:US
Practice Address - Phone:603-742-9222
Practice Address - Fax:603-742-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005077Medicaid
NHE16151Medicare UPIN
NHRE2143Medicare ID - Type Unspecified