Provider Demographics
NPI:1114962602
Name:LACERNA, ROGENER B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGENER
Middle Name:B
Last Name:LACERNA
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 1:5319 MEADOW LANE CT
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1469
Mailing Address - Country:US
Mailing Address - Phone:440-934-0740
Mailing Address - Fax:440-934-0740
Practice Address - Street 1:5319 MEADOW LANE CT
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1469
Practice Address - Country:US
Practice Address - Phone:440-934-0740
Practice Address - Fax:440-934-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0556910Medicaid
OHA15735Medicare UPIN
OH0549532Medicare PIN
OH0556910Medicaid
OHH098690Medicare PIN