Provider Demographics
NPI:1184670523
Name:ROGERS, BARBARA (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 KENILWORTH DRIVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2146
Mailing Address - Country:US
Mailing Address - Phone:410-296-4616
Mailing Address - Fax:410-337-5068
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 317
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:410-296-4616
Practice Address - Fax:410-337-5068
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN358481L367500000X
MDR078973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01312471OtherRAILROAD MEDICARE
PA101572VKCOtherNOVITAS MEDICARE
PA101621261Medicaid
MD553301500Medicaid
MD572480ZCXJOtherNOVITAS MEDICARE
PA101572Medicare PIN