MEDICARE: CAROL M ROGERS CONP

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	363L00000X	Nurse Practitioner	F3700121	NY
2	363LF0000X	Family Nurse Practitioner	F3301131	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790774354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL M ROGERS CONP

Provider Business Mailing Address
First Line	:	30 HARRISON ST
Second Line	:	SUITE 100
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2161
Country	:	US
Telephone Number	:	607-763-6850
Fax Number	:	607-763-6703

Provider Business Practice Location Address
First Line	:	30 HARRISON ST
Second Line	:	SUITE 100
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2161
Country	:	US
Telephone Number	:	607-763-6850
Fax Number	:	607-763-6703

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	09/11/2025

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