Provider Demographics
NPI:1245297795
Name:MALAGON-ROGERS, MARICARMEN (MD)
Entity type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:MALAGON-ROGERS
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 1:1924 ALCOA HWY
Mailing Address - Street 2:U-67
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-544-9352
Mailing Address - Fax:865-544-9314
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:U-115
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9351
Practice Address - Fax:865-544-9314
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0210772080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100011932OtherPHP TENNCARE
TN5349187OtherAETNA
KY64922214Medicaid
TN1689631137OtherGROUP NPI
TN3140062OtherUNITED HEALTH CARE
TN3373352OtherUFP MEDICAID GROUP
TN3057890Medicaid
TN7366660OtherCIGNA
TN4036989OtherBLUE CROSS/BLUE SHIELD
TN3373352OtherUFP MEDICARE GROUP
TNTN01H4OtherJOHN DEERE
TN3373352OtherUFP MEDICARE GROUP
E80528Medicare UPIN