Basic Information
| Provider Information | |||||||||
| NPI: | 1912642414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | ROBYNN | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 NORTH UNION STREET | ||||||||
| Address2: | |||||||||
| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163757500 | ||||||||
| FaxNumber: | 7167011557 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 NORTH UNION STREET | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166889641 | ||||||||
| FaxNumber: | 7168292447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2022 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.