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Provider Information for 1770556458

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ROGER C NUSS MD

Gender: MALE

Individual NPI: 1770556458

Calendar   Last Updated:  2008-07-02
  Certification Date: 

Details

Name Value
NPI 1770556458
Enumeration Date 2006-02-11
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE LO-367
BOSTON, MA 02115-5724
United States

Phone: 617-355-6417 | Fax: 617-730-0611
View Map External Link
Primary Practice Address 333 LONGWOOD AVE FLOOR 3
BOSTON, MA 02115-5711
United States

Phone: 617-355-6460 | Fax: 617-730-0337
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 3107035
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Y00000X - Otolaryngology MA 77542