Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101026539 | VA |
N | 2080P0205X | Pediatric Endocrinologist | 01064703 | IN |
NPI | 1346319985 |
---|---|
Provider Name | Alan D. Rogol |
First Address | Charlottesville, VA 22903-2981 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006057161 | (05) | VA |
200894180 | (05) | IN |
B04998 | (02) | VA |