Basic Information
| Provider Information | |||||||||
| NPI: | 1023324142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIMOTHY A ROGGE, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 182ND AVE NE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980521318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255556982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10200 NE 132ND ST | ||||||||
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| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980342831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258212000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | RENO | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING/CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4258682921 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD00013258 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.