Provider Demographics
NPI:1700979937
Name:ROEGNER, JOHN AXFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:AXFORD
Last Name:ROEGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:919 WESTMINSTER ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4129
Mailing Address - Country:US
Mailing Address - Phone:202-387-8872
Mailing Address - Fax:
Practice Address - Street 1:4151 BLADENSBURG RD
Practice Address - Street 2:
Practice Address - City:COLMAR MANOR
Practice Address - State:MD
Practice Address - Zip Code:20722-1928
Practice Address - Country:US
Practice Address - Phone:301-699-7700
Practice Address - Fax:301-779-9001
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035977207Q00000X
WAMD60088167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD035977OtherMEDICAL LICENSE