Healthcare Provider Details

I. General information

NPI: 1093165086
Provider Name (Legal Business Name): NICHOLAS ALAN ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 FOSTER AVE
BALTIMORE MD
21224-4335
US

IV. Provider business mailing address

842 PARK AVE APT 4
BALTIMORE MD
21201-4873
US

V. Phone/Fax

Practice location:
  • Phone: 501-690-5894
  • Fax:
Mailing address:
  • Phone: 501-690-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101270050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: