Provider Demographics
NPI:1164501102
Name:ROGERS, JONATHAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MAY APPLE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4998
Mailing Address - Country:US
Mailing Address - Phone:210-268-8941
Mailing Address - Fax:
Practice Address - Street 1:110 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5151
Practice Address - Country:US
Practice Address - Phone:210-268-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3932207L00000X
MDD65389207L00000X
PAMD446741207L00000X
AZ37455207L00000X
WAMD60175699207L00000X
MTMED-PHYS-LIC-12462207L00000X
FLME99871207L00000X
HIMD-14484207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology