Provider Demographics
NPI:1114499357
Name:ROGGERO, CHAD
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:ROGGERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HERRICK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2796
Mailing Address - Country:US
Mailing Address - Phone:978-927-3040
Mailing Address - Fax:978-927-0443
Practice Address - Street 1:77 HERRICK ST STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2796
Practice Address - Country:US
Practice Address - Phone:978-927-3040
Practice Address - Fax:978-927-0443
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant