Provider Demographics
NPI:1174550016
Name:SROGA, MARY F (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:SROGA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:F
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2912 SPRINGBORO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-297-4852
Practice Address - Street 1:77 E WOODBURY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2855
Practice Address - Country:US
Practice Address - Phone:937-277-1722
Practice Address - Fax:937-277-8618
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.03552-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506111OtherCARESOURCE
OH421534506117OtherCARESOURCE
OH000000558163OtherBCBS-OH
OH2059203Medicaid
OH2059203Medicaid
OHSRNP10363Medicare PIN
OH$$$$$$$$$001OtherMMOH