Provider Demographics
NPI:1013063163
Name:RODGERS, MARGARET LAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:LAKE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 EUREKA WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0210
Mailing Address - Country:US
Mailing Address - Phone:530-243-0303
Mailing Address - Fax:530-243-3821
Practice Address - Street 1:2888 EUREKA WAY STE 201
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0210
Practice Address - Country:US
Practice Address - Phone:530-243-0303
Practice Address - Fax:530-243-3821
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57163Medicare UPIN