Provider Demographics
NPI:1962492827
Name:ROGG, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:ROGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI73522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007352OtherTUFTS
720051801OtherCIGNA
MA3206068Medicaid
7352OtherFEP BLUE CROSS
000000001988OtherNRPRI
007000614OtherHOSPITALPIN
3206068OtherHEALTHY START
7000614OtherRI MEDICAL ASSISTANCE
004373OtherBLUECHIP
003109453OtherCT MED ASSISTANCE
007352OtherBLUE SHIELD
240164OtherRIHPILGRIM
1600203OtherUNITED HEALTH PLANS
300067433OtherRAILROAD MEDICARE
240164OtherW&I PILGRIM