Provider Demographics
NPI:1871692020
Name:ROGERS, MELISSA B (PAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 UPNOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3425
Mailing Address - Country:US
Mailing Address - Phone:410-533-3146
Mailing Address - Fax:
Practice Address - Street 1:341 N CALVERT ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3654
Practice Address - Country:US
Practice Address - Phone:410-986-4400
Practice Address - Fax:410-986-4411
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT0003367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK647R105Medicare PIN