Provider Demographics
NPI:1851343545
Name:ROGOVIN, CALEB A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:A
Last Name:ROGOVIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:CALEB
Other - Middle Name:A
Other - Last Name:ROGOVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:5501 OLD YORK RD STE 3006
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7979
Practice Address - Fax:215-456-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN283644L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered