Provider Demographics
NPI:1023324142
Name:TIMOTHY A ROGGE, MD, PC
Entity type:Organization
Organization Name:TIMOTHY A ROGGE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-868-2921
Mailing Address - Street 1:12900 182ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1318
Mailing Address - Country:US
Mailing Address - Phone:425-555-6982
Mailing Address - Fax:
Practice Address - Street 1:10200 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2831
Practice Address - Country:US
Practice Address - Phone:425-821-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000132582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty