MEDICARE: MS. REBECCA ELLEN ROGERS MA, RD, LDN

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	133N00000X	Nutritionist	DN000946	PA
2	133V00000X	Registered Dietitian	DN000946	PA

General Provider Information

NPI Number	:	1972807055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA ELLEN ROGERS MA, RD, LDN

Provider Business Mailing Address
First Line	:	621 CHELTEN HILLS DR
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1319
Country	:	US
Telephone Number	:	267-269-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 1ST AVE
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-1401
Country	:	US
Telephone Number	:	267-269-4741
Fax Number	:

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

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	07/24/2023

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