Provider Demographics
NPI:1588608913
Name:ROGER ROGALSKI MD CHTD
Entity Type:Organization
Organization Name:ROGER ROGALSKI MD CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES SEC ETC
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-841-9991
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:#105
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-841-9991
Mailing Address - Fax:775-841-9485
Practice Address - Street 1:1516 VIRGINIA RANCH RD
Practice Address - Street 2:BLDG. A, SUITE 101
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5730
Practice Address - Country:US
Practice Address - Phone:775-841-9991
Practice Address - Fax:775-841-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6391207X00000X, 207XX0005X
CAG71822207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G718220OtherCALIF MEDI-CAL ID
NVV39080Medicare PIN
NV0704280002Medicare NSC
B49213Medicare UPIN
CAZZZ29464ZMedicare PIN