Provider Demographics
NPI:1366449605
Name:ROGERS, DILWORTH THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DILWORTH
Middle Name:THOMAS
Last Name:ROGERS
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 1:39 KAMEHAMEHA AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2263
Mailing Address - Country:US
Mailing Address - Phone:808-877-7078
Mailing Address - Fax:808-871-4702
Practice Address - Street 1:39 KAMEHAMEHA AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-7078
Practice Address - Fax:808-871-4702
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 10291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08890101Medicaid
HI51129Medicare ID - Type Unspecified
HI08890101Medicaid