Provider Demographics
NPI:1972638187
Name:ROGSTAD, AMY S (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:ROGSTAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6430 ROCKLEDGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1847
Mailing Address - Country:US
Mailing Address - Phone:301-468-1451
Mailing Address - Fax:301-468-3580
Practice Address - Street 1:6430 ROCKLEDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1847
Practice Address - Country:US
Practice Address - Phone:301-468-1451
Practice Address - Fax:301-468-3580
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0068778207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417911100Medicaid
MD417911100Medicaid