Mitty, Roger D
Mitty, Roger D is an individual health care provider with primary practice located at 11 Nevins St , Brighton MA 02135-3514. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Mitty, Roger D can be contacted via phone (617) 562-5432.Contact Information
Primary practice address
11 Nevins St
Brighton MA 02135-3514
Phone: (617) 562-5432
Fax: (617) 789-5049
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 779172 | New York |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 74173 | Massachusetts |
Profile Details
| NPI number | 1902894025 |
|---|---|
| LBN Legal business name | Mitty, Roger D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 12th, 2005 |
| Last updated | Oct 21st, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902894025 | NPPES |
| Massachusetts | MEDICAID | 3125734 |
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