Provider Demographics
NPI:1316981954
Name:ROGACHEFSKY, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ROGACHEFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 W. 6TH STREET #305N
Mailing Address - Street 2:1360 W. 6TH STREET #305N
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:424-570-4810
Mailing Address - Fax:424-218-0874
Practice Address - Street 1:15901 HAWTHORNE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2655
Practice Address - Country:US
Practice Address - Phone:714-434-8663
Practice Address - Fax:714-549-9287
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99035207XS0106X
NY212390-12086S0105X
CAG89005207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316981954OtherTYPE 1 NPI
CA1316981954OtherTYPE 1 NPI
F69256Medicare UPIN