Basic Information
Provider Information
NPI: 1174691307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROGERS
FirstName: PATRICIA
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1351 MOUNT HOPE AVE
Address2: SUITE 116
City: ROCHESTER
State: NY
PostalCode: 146203917
CountryCode: US
TelephoneNumber: 5852752559
FaxNumber: 5852758113
Practice Location
Address1: 601 ELMWOOD AVE
Address2: BOX 278984
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852752559
FaxNumber: 5852758113
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 06/02/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XF301501NYY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


Home