Provider Demographics
NPI:1649253907
Name:ROGOFF, FREDERICK D (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:ROGOFF
Suffix:
Gender:M
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:PO BOX 9159
Mailing Address - Street 2:203 MILLS AVE
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-9159
Mailing Address - Country:US
Mailing Address - Phone:864-271-1844
Mailing Address - Fax:864-271-2147
Practice Address - Street 1:203 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29604
Practice Address - Country:US
Practice Address - Phone:864-271-1844
Practice Address - Fax:864-271-2147
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9759207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC097594Medicaid
B92404Medicare UPIN
SC097594Medicaid