Healthcare Provider Details

I. General information

NPI: 1346319985
Provider Name (Legal Business Name): ALAN D. ROGOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEE ST
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

500 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101026539
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number01064703
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: