Provider Demographics
NPI:1063541647
Name:GERALD D. ROGELL, M.D., P.A.
Entity type:Organization
Organization Name:GERALD D. ROGELL, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROGELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-468-1381
Mailing Address - Street 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE #404
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-468-1381
Mailing Address - Fax:301-816-1079
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE #404
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-468-1381
Practice Address - Fax:301-816-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD901211Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER