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1336171628

NPI Code Detail

MEDICARE: MARISA A ROGERS MD

MEDICARE: MARISA A ROGERS MD

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	207R00000X	Internal Medicine Physician	MD17508	RI
2	207R00000X	Internal Medicine Physician	88073	GA
3	207R00000X	Internal Medicine Physician	MD.42370	AL
4	207R00000X	Internal Medicine Physician	MD421609	PA
5	207R00000X	Internal Medicine Physician	0101273755	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336171628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA A ROGERS MD

Provider Business Mailing Address
First Line	:	PO BOX 746722
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6722
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	5246 CHAMBERLAYNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2950
Country	:	US
Telephone Number	:	804-913-7029
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/11/2025

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Directions to “ MARISA A ROGERS MD” Practice Location

Language	Start Address	Practice Location

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