Healthcare Provider Details

I. General information

NPI: 1114993227
Provider Name (Legal Business Name): MICHAEL ROGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 PITTSTON AVE
SCRANTON PA
18505-4556
US

IV. Provider business mailing address

2232 PITTSTON AVE REAR OF
SCRANTON PA
18505-4802
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-2100
  • Fax:
Mailing address:
  • Phone: 570-510-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041440L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMD041440L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD041440L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012146560004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: