Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12125 | MA |
Y | 213EG0000X | General Practice | 12125 | MA |
NPI | 1003820598 |
---|---|
Provider Name | Dr. Alan Mark Rogol |
First Address | Walpole, MA 02081-2806 |
Second Address | Walpole, MA 02081-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |