Provider Demographics
NPI:1972657120
Name:RODGERS-RIEGER, ELENA R (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:R
Last Name:RODGERS-RIEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:ROSE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2036
Mailing Address - Country:US
Mailing Address - Phone:701-222-2480
Mailing Address - Fax:701-222-4537
Practice Address - Street 1:3502 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0761
Practice Address - Country:US
Practice Address - Phone:012-222-4807
Practice Address - Fax:701-222-4537
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10598207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17338Medicaid
NDN718256Medicare PIN