Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD046823L | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD046823L | PA |
NPI | 1194891069 |
---|---|
Provider Name | Dr. Edwin J Rogusky |
First Address | State College, PA 16801-7965 |
Second Address | State College, PA 16801-7965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1304539 | (05) | PA |
E91419 | (02) | PA |