Provider Demographics
NPI:1053359935
Name:ROGOVITZ, DAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ROGOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 LAKE AV. NORTH
Mailing Address - Street 2:UMASS MEMORIAL MEDICAL CENTER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:508-334-1000
Mailing Address - Fax:508-334-1000
Practice Address - Street 1:55 LAKE AV NORTH
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:508-334-1000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI1612962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3208338Medicaid
MARO A30744Medicare ID - Type Unspecified
MA3208338Medicaid