Provider Demographics
NPI:1902816630
Name:ROGERSON, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ROGERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 BUDFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3214
Mailing Address - Country:US
Mailing Address - Phone:814-262-3950
Mailing Address - Fax:814-262-3990
Practice Address - Street 1:348 BUDFIELD STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-262-3950
Practice Address - Fax:814-262-3990
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016845E207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007090960003Medicaid
PA049255K47Medicare PIN
PA0007090960003Medicaid