Provider Demographics
NPI:1619969037
Name:ROGERSON ORTHOPEDIC APPLIANCES INC
Entity Type:Organization
Organization Name:ROGERSON ORTHOPEDIC APPLIANCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER / PRACTICE MANAGE
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-268-1135
Mailing Address - Street 1:483 SOUTHAMPTON ST
Mailing Address - Street 2:P.O. BOX 493
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2732
Mailing Address - Country:US
Mailing Address - Phone:617-268-1135
Mailing Address - Fax:617-269-3373
Practice Address - Street 1:483 SOUTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2732
Practice Address - Country:US
Practice Address - Phone:617-268-1135
Practice Address - Fax:617-269-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1504398Medicaid
MA700043OtherHARVARD PILGRIM
MA171354OtherBLUE CROSS BLUE SHIELD
MA800359OtherTUFTS HEALTH PLAN
MA171354OtherBLUE CROSS BLUE SHIELD