Provider Demographics
NPI:1255508644
Name:RODGERS, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:RODGERS
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0840
Mailing Address - Country:US
Mailing Address - Phone:877-574-7116
Mailing Address - Fax:419-223-2726
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:THOMAS MEMORIAL HOSPITAL
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-343-4625
Practice Address - Fax:304-343-4626
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4482532085R0202X
WV238722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440823Medicaid
WV3810027319Medicaid