Provider Demographics
NPI:1619012291
Name:ROGERS, JONATHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 535
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-469-4000
Mailing Address - Fax:410-469-4074
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 535
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-469-4000
Practice Address - Fax:410-469-4074
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD65722207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412623800Medicaid
MD896945-01OtherBLUE CROSS/BLUE SHIELD
MDQ299Medicare PIN
MDP00608494Medicare PIN