Provider Demographics
NPI:1811004179
Name:ROGGIN, KEVIN KING (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KING
Last Name:ROGGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-1414
Mailing Address - Fax:
Practice Address - Street 1:86 JONATHAN LUCAS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-1443
Practice Address - Country:US
Practice Address - Phone:843-876-4268
Practice Address - Fax:843-876-3046
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD906722086X0206X
IL0361140742086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114074OtherSTATE LICENSE NUMBER
IL0081648680OtherBCBS PROVIDER #
ILI40771Medicare UPIN