Provider Demographics
NPI:1578738506
Name:ZIMBRICK-ROGERS, CHARLES GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GILBERT
Last Name:ZIMBRICK-ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:GILBERT
Other - Last Name:ROGERS
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3501 CIVIC CENTER BLVD BLDG 12TH
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3820
Mailing Address - Country:US
Mailing Address - Phone:215-590-3938
Mailing Address - Fax:
Practice Address - Street 1:3501 CIVIC CENTER BLVD BLDG 12TH
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3820
Practice Address - Country:US
Practice Address - Phone:215-590-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443117102L00000X, 208000000X, 2080A0000X
NJ25MA10691300102L00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No208000000XAllopathic & Osteopathic PhysiciansPediatrics