Basic Information
| Provider Information | |||||||||
| NPI: | 1306933197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGINSKY TSESIS | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 GREENLEIGH AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLE RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212202004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109336423 | ||||||||
| FaxNumber: | 4109331390 | ||||||||
| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B202 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154552752 | ||||||||
| FaxNumber: | 8154552789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 45061-020 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036120187 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D90687 | MD | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036.120187 | 01 | IL | LICENSE NUMBER | OTHER | 100013416 | 05 | WI | MEDICAID | 036120187 | 01 | IL | STATE LICENSE | OTHER |