MEDICARE: ROGER W WASHINGTON M.D.

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	207Q00000X	Family Medicine Physician	G52316	CA

General Provider Information

NPI Number	:	1295812816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER W WASHINGTON M.D.

Provider Business Mailing Address
First Line	:	885 SCOTT BLVD STE 4
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5255
Country	:	US
Telephone Number	:	408-246-9926
Fax Number	:	408-246-7877

Provider Business Practice Location Address
First Line	:	2365 QUIMBY RD STE 260
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1337
Country	:	US
Telephone Number	:	408-246-9926
Fax Number	:	408-246-7877

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/27/2021

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