MEDICARE: ALLISA ROGERS RDMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	178544	VA

General Provider Information

NPI Number	:	1275317117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISA ROGERS RDMS

Provider Business Mailing Address
First Line	:	9740 MIDLOTHIAN TPKE
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4972
Country	:	US
Telephone Number	:	804-601-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9740 MIDLOTHIAN TPKE
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4972
Country	:	US
Telephone Number	:	804-601-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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