Provider Demographics
NPI:1073950762
Name:ROGERS, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:WANAKER BUILDING. 6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:215-590-2897
Mailing Address - Fax:
Practice Address - Street 1:1700 HORIZON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3950
Practice Address - Country:US
Practice Address - Phone:215-822-7700
Practice Address - Fax:215-822-2296
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT203899208000000X
PAMD457685208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics