Provider Demographics
NPI:1750386900
Name:ROGERS, GREGG LEE (ARNP)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:LEE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAPLE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03227-3440
Mailing Address - Country:US
Mailing Address - Phone:603-630-7852
Mailing Address - Fax:
Practice Address - Street 1:298 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-4204
Practice Address - Country:US
Practice Address - Phone:603-447-8900
Practice Address - Fax:603-447-8900
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH074751-23363LP0808X
FLARNP9218687363LF0000X, 363LP0200X
NH07475123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306803000Medicaid
FLFV666ZMedicare PIN