Provider Demographics
NPI:1356597959
Name:RICHARD A ROGACHEFSKY M.D. PA
Entity type:Organization
Organization Name:RICHARD A ROGACHEFSKY M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGACHEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-222-7382
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0109
Mailing Address - Country:US
Mailing Address - Phone:714-434-8663
Mailing Address - Fax:714-549-9287
Practice Address - Street 1:15901 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2655
Practice Address - Country:US
Practice Address - Phone:714-434-8663
Practice Address - Fax:714-549-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99035207X00000X, 207XS0106X
CAG89005207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356597959OtherTYPE 2 NPI
CAG89005OtherLICENSE
CAFM752AMedicare PIN
FL23173AMedicare PIN