1912193269 NPI number — MR. GEORGE T ROGERS C.O.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912193269 NPI number — MR. GEORGE T ROGERS C.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
GEORGE
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.O.
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:
1912193269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 PLEASANT STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-226-0106
Provider Business Mailing Address Fax Number:
603-226-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 BUTTRICK RD BLDG B
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
LONDONDERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03053-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-425-0106
Provider Business Practice Location Address Fax Number:
603-226-0845
Provider Enumeration Date:
09/20/2007

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020504606 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1209857Y0NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 143190000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30760132 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006572 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7628001 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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