Provider Demographics
NPI:1154381614
Name:ROALSVIG, KNUT (MD)
Entity type:Individual
Prefix:DR
First Name:KNUT
Middle Name:
Last Name:ROALSVIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-432-8802
Mailing Address - Fax:603-432-7430
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 301
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-432-8802
Practice Address - Fax:603-432-7430
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7923207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7835426OtherAETNA
NH0442842OtherUNITED HEALTHCARE
NH716101OtherTUFTS
NH30002464Medicaid
NH716101OtherTUFTS
NH7835426OtherAETNA