Provider Demographics
NPI:1992032403
Name:ROGERS GYNECOLOGY & WOMEN'S HEALTH, PLLC
Entity Type:Organization
Organization Name:ROGERS GYNECOLOGY & WOMEN'S HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-465-4455
Mailing Address - Street 1:121 EDINBURGH SOUTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6448
Mailing Address - Country:US
Mailing Address - Phone:919-465-4455
Mailing Address - Fax:919-465-2211
Practice Address - Street 1:121 EDINBURGH SOUTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6448
Practice Address - Country:US
Practice Address - Phone:919-465-4455
Practice Address - Fax:919-465-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00622261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910060Medicaid
NC8910060Medicaid
NC2198635AMedicare PIN