MEDICARE: VICENTE ROGER, MD PA

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	174400000X	Specialist	ME0055378	FL
2	174400000X	Specialist
3	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1538110168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICENTE ROGER, MD PA

Provider Business Mailing Address
First Line	:	1069 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-868-5181
Fax Number	:	305-868-8292

Provider Business Practice Location Address
First Line	:	1069 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-868-5181
Fax Number	:	305-868-8292

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. WENDY ROBIN GLABERSON
Credential	:	M.D.
Telephone Number	:	305-868-5181

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/13/2023

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