1124099981 NPI number — ROBERT W ROGERS OD

Table of content: ROBERT W ROGERS OD (NPI 1124099981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124099981 NPI number — ROBERT W ROGERS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
ROBERT
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124099981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 LIGONIER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-1882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-539-1671
Provider Business Mailing Address Fax Number:
724-539-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 LIGONIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-539-1671
Provider Business Practice Location Address Fax Number:
724-539-1654
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  OEG001241 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0008463350004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008463350001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00433387 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008463350005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008463350003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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