Provider Demographics
NPI:1295812816
Name:WASHINGTON, ROGER W (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:885 SCOTT BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5255
Mailing Address - Country:US
Mailing Address - Phone:408-246-9926
Mailing Address - Fax:408-246-7877
Practice Address - Street 1:2365 QUIMBY RD STE 260
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1337
Practice Address - Country:US
Practice Address - Phone:408-246-9926
Practice Address - Fax:408-246-7877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G523162Medicare ID - Type Unspecified