Provider Demographics
NPI:1689145070
Name:MICHAEL J ROGAN MD
Entity Type:Organization
Organization Name:MICHAEL J ROGAN MD
Other - Org Name:ROGAN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-273-0900
Mailing Address - Street 1:2232 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-4556
Mailing Address - Country:US
Mailing Address - Phone:570-273-0900
Mailing Address - Fax:
Practice Address - Street 1:2232 PITTSTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-4556
Practice Address - Country:US
Practice Address - Phone:570-273-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse PediatricsGroup - Multi-Specialty