Provider Demographics
NPI:1245238385
Name:ROGERS, STEPHEN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-738-7750
Mailing Address - Fax:401-738-9750
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:STE 503
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-738-7750
Practice Address - Fax:401-738-9750
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00279213E00000X
MADPM2323213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005625Medicaid
RI212867OtherBLUE CROSS
RI401295OtherBLUECHIP
RI212867OtherBLUE CROSS
U51598Medicare UPIN
RI7005625Medicaid