Provider Demographics
NPI:1578329975
Name:ROGERS, AHMED (CRNP-AGPC)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CRNP-AGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BATH RD APT Q11
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2751
Mailing Address - Country:US
Mailing Address - Phone:609-325-1577
Mailing Address - Fax:
Practice Address - Street 1:1717 BATH RD APT Q11
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2751
Practice Address - Country:US
Practice Address - Phone:609-325-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028431363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology