Provider Demographics
NPI:1194715490
Name:ROGAL, ANNE P (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:P
Last Name:ROGAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2100 DORCHESTER AVE
Mailing Address - Street 2:SUITE 2203
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5615
Mailing Address - Country:US
Mailing Address - Phone:617-296-1269
Mailing Address - Fax:617-298-4340
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:SUITE 2203
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-1269
Practice Address - Fax:617-298-4340
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-05-13
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Provider Licenses
StateLicense IDTaxonomies
MA59594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1302353Medicaid
MA1302353Medicaid
MAJ07628Medicare PIN