Provider Demographics
NPI:1346227063
Name:ROGERS, RICHARD ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
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 1:6100 OLD 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:717-541-0988
Mailing Address - Fax:717-412-4882
Practice Address - Street 1:6100 OLD 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:717-541-0988
Practice Address - Fax:717-412-4882
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002775L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010045970005Medicaid
PA0010045970001Medicaid
PA0010045970004Medicaid
PA0010045970006Medicaid
PA089690Medicare ID - Type Unspecified
PA1149270004Medicare NSC
T72736Medicare UPIN
PA0010045970004Medicaid
PA1149270001Medicare NSC
PA1149270002Medicare NSC