Provider Demographics
NPI:1710634472
Name:ROGERS, MACKENZIE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N MAIN RD
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:MA
Mailing Address - Zip Code:01253-9726
Mailing Address - Country:US
Mailing Address - Phone:413-485-8374
Mailing Address - Fax:
Practice Address - Street 1:66 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2927
Practice Address - Country:US
Practice Address - Phone:413-562-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology