Provider Demographics
NPI:1225038037
Name:ROGERS, DAVID A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2607
Mailing Address - Country:US
Mailing Address - Phone:717-671-9688
Mailing Address - Fax:717-541-8838
Practice Address - Street 1:6100 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2607
Practice Address - Country:US
Practice Address - Phone:717-671-9688
Practice Address - Fax:717-541-8838
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2020-05-13
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAPS004366-L103T00000X
PAPS004366L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA032689OtherBLUESHIELD PIN
PAA130913OtherVALUEOPTIONS PIN
PA01118301OtherBLUECROSS PIN
PA01118301OtherBLUECROSS PIN