Provider Demographics
NPI:1558495580
Name:ROGERS, KENNETH THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THOMAS
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 COLUMBIA RD NW
Mailing Address - Street 2:UNIT 316
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5155
Mailing Address - Country:US
Mailing Address - Phone:202-248-9089
Mailing Address - Fax:
Practice Address - Street 1:1884 COLUMBIA RD NW
Practice Address - Street 2:UNIT 316
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5155
Practice Address - Country:US
Practice Address - Phone:202-248-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO168192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry