Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 0101035199 | VA |
NPI | 1073526703 |
---|---|
Provider Name | Suzanne Rogacz |
First Address | Fairfax, VA 22031-2238 |
Second Address | Fairfax, VA 22031-2238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6042252 | (05) | VA |
E23096 | (02) |