Provider Demographics
NPI:1215993837
Name:JAMMAL, ROGER GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GEORGE
Last Name:JAMMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:ULRICH CITY CENTRE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5368
Mailing Address - Country:US
Mailing Address - Phone:716-433-1791
Mailing Address - Fax:716-439-1233
Practice Address - Street 1:ULRICH CITY CENTRE
Practice Address - Street 2:SUITE 7
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5368
Practice Address - Country:US
Practice Address - Phone:716-433-1791
Practice Address - Fax:716-439-1233
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY159169207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00929557Medicaid