Provider Demographics
NPI:1184684268
Name:ROGERS, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:831 KINGS HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3162
Mailing Address - Country:US
Mailing Address - Phone:856-853-8730
Mailing Address - Fax:856-853-8870
Practice Address - Street 1:831 KINGS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3162
Practice Address - Country:US
Practice Address - Phone:856-853-8730
Practice Address - Fax:856-853-8870
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04600600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4719631OtherCIGNA
NJ01000219800OtherAMERICHOICE
NJ000581756OtherIBC
NJ000786022001OtherUNITED HEALTHCARE
NJ1083262OtherHORIZON NJ HEALTH
NJ4312499OtherAETNA
NJF12332OtherHEALTHNET
NJP535135OtherOXFORD
NJ0403475000OtherAMERIHEALTH
NJ223318839OtherHORIZON
NJ2502208Medicaid
NJ84294OtherAMERIGROUP
NJ223318839OtherHORIZON
NJ581756CN1Medicare PIN