Provider Demographics
NPI:1992713622
Name:ROGGEN, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ROGGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6417
Mailing Address - Country:US
Mailing Address - Phone:410-653-0000
Mailing Address - Fax:410-653-5531
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6417
Practice Address - Country:US
Practice Address - Phone:410-653-0000
Practice Address - Fax:410-653-5531
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD35844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN6601OtherR/R MEDICARE GROUP #
MD061141700Medicaid
MD110167456OtherR/R MEDICARE PROVIDER #
MDKL33216LMedicare PIN
MDE45598Medicare UPIN
MD061141700Medicaid