MEDICARE: MR. ROGERS FON ATIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1679349096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGERS FON ATIE

Provider Business Mailing Address
First Line	:	3409 DODGE PARK RD APT 301
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2021
Country	:	US
Telephone Number	:	513-799-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 DODGE PARK RD APT 301
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2021
Country	:	US
Telephone Number	:	513-799-1067
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	10/28/2025

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