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:
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Health care specialties

SpecialtyCodeLicense #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 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902894025 NPPES
Massachusetts MEDICAID 3125734

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