Provider Demographics
NPI:1902885296
Name:COMPENDIO, ROEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROEL
Middle Name:D
Last Name:COMPENDIO
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 1:9 MALIN STATION RD.
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1676
Mailing Address - Country:US
Mailing Address - Phone:610-240-0240
Mailing Address - Fax:610-240-0335
Practice Address - Street 1:15 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-240-0240
Practice Address - Fax:610-240-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063208L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81296Medicare UPIN
PA020415P0TMedicare ID - Type Unspecified
PA020415P0TMedicare ID - Type Unspecified
PA001717280Medicaid