Individual
ROGER D MITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 NEVINS ST, BRIGHTON, MA 02135-3514
(617) 562-5432
(617) 789-5049
Mailing address
11 NEVINS ST, BRIGHTON, MA 02135-3514
(617) 562-5432
(617) 789-5049
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
779172
NY
207RG0100X
Gastroenterology Physician
Primary
74173
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3125734
—
MA
Enumeration date
10/12/2005
Last updated
10/21/2011
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