Provider Demographics
NPI:1346664786
Name:PETER R ROGOL MD LLC
Entity Type:Organization
Organization Name:PETER R ROGOL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-248-8800
Mailing Address - Street 1:2080 WHITNEY AVE
Mailing Address - Street 2:210
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3600
Mailing Address - Country:US
Mailing Address - Phone:203-248-8800
Mailing Address - Fax:203-288-5264
Practice Address - Street 1:2080 WHITNEY AVE
Practice Address - Street 2:210
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3600
Practice Address - Country:US
Practice Address - Phone:203-248-8800
Practice Address - Fax:203-288-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024790207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty