Provider Demographics
NPI:1811925621
Name:ROGERS, LINDSEY R (PA)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LINDSEY
Other - Middle Name:R
Other - Last Name:HEROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:322 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2237
Mailing Address - Country:US
Mailing Address - Phone:716-366-7150
Mailing Address - Fax:716-366-1976
Practice Address - Street 1:322 PARK AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2237
Practice Address - Country:US
Practice Address - Phone:716-366-7150
Practice Address - Fax:716-366-1976
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0100301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570534001OtherBLUE CROSS BLUE SHIELD
NY9512779OtherIHA