Provider Demographics
NPI:1831403047
Name:JANET L. ROGGE, M.D. PS
Entity type:Organization
Organization Name:JANET L. ROGGE, M.D. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-5355
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:STE 1259
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-624-5355
Mailing Address - Fax:206-624-5430
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:STE 1259
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-624-5355
Practice Address - Fax:206-624-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00014838OtherLICENSE
WA50D0713310OtherCLIA
WAG000104569Medicare PIN
WAA05499Medicare UPIN