Provider Demographics
NPI:1528008596
Name:RODGERS, THOMAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
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 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:455 MAPLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814
Practice Address - Country:US
Practice Address - Phone:607-562-8901
Practice Address - Fax:607-562-7443
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173551207Q00000X
NY173351207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1733518OtherWORKERS COMP
NY01067990Medicaid
NY1733518OtherWORKERS COMP
NY1733518OtherWORKERS COMP
NYJ400067069Medicare PIN