Provider Demographics
NPI:1871709287
Name:POIRE, ROGER EUGENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:EUGENE
Last Name:POIRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7401
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7401
Mailing Address - Country:US
Mailing Address - Phone:603-528-4405
Mailing Address - Fax:603-528-2176
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6972
Practice Address - Country:US
Practice Address - Phone:603-528-4405
Practice Address - Fax:603-528-2176
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH436103T00000X, 103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHPORE1210Medicare ID - Type UnspecifiedMEDICARE ID NUMBER