Provider Demographics
NPI:1275258543
Name:ROGERS, JOSEPH BOB (DNP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BOB
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 MEDFORD DR APT 40
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2770
Mailing Address - Country:US
Mailing Address - Phone:571-230-2226
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDFORD DR APT 40
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2770
Practice Address - Country:US
Practice Address - Phone:571-230-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health