Provider Demographics
NPI:1215052006
Name:ROGOFF, MAI-LAN A (MD)
Entity type:Individual
Prefix:
First Name:MAI-LAN
Middle Name:A
Last Name:ROGOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U MASS MEDICAL SCHOOL
Mailing Address - Street 2:55 LAKE AVENUE NORTH
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:508-856-2285
Mailing Address - Fax:
Practice Address - Street 1:UMASS MEDICAL SCHOOL
Practice Address - Street 2:55 LAKE AVE NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-856-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA445902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry