Healthcare Provider Details

I. General information

NPI: 1619969037
Provider Name (Legal Business Name): ROGERSON ORTHOPEDIC APPLIANCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 SOUTHAMPTON ST
BOSTON MA
02127-2732
US

IV. Provider business mailing address

483 SOUTHAMPTON ST P.O. BOX 493
BOSTON MA
02127-2732
US

V. Phone/Fax

Practice location:
  • Phone: 617-268-1135
  • Fax: 617-269-3373
Mailing address:
  • Phone: 617-268-1135
  • Fax: 617-269-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA A ROGERSON
Title or Position: CORPORATE OFFICER / PRACTICE MANAGE
Credential:
Phone: 617-268-1135