Provider Demographics
NPI:1043596588
Name:ROGEL, LAUREN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROSE
Last Name:ROGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ROSE
Other - Last Name:BRICKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:270 E. STATE ST.
Mailing Address - Street 2:STE. 240
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4369
Mailing Address - Country:US
Mailing Address - Phone:330-596-6560
Mailing Address - Fax:330-596-6575
Practice Address - Street 1:270 E. STATE ST.
Practice Address - Street 2:STE. 240
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4369
Practice Address - Country:US
Practice Address - Phone:330-596-6560
Practice Address - Fax:330-596-6575
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3382363A00000X
OH50-003382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122854Medicaid
OHH291012Medicare PIN
OHH291011Medicare PIN