Provider Demographics
NPI:1710946447
Name:MICHAEL S ROGERS MD PA
Entity Type:Organization
Organization Name:MICHAEL S ROGERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-853-8730
Mailing Address - Street 1:831 KINGS HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3162
Mailing Address - Country:US
Mailing Address - Phone:856-853-8730
Mailing Address - Fax:856-853-8870
Practice Address - Street 1:831 KINGS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3162
Practice Address - Country:US
Practice Address - Phone:856-853-8730
Practice Address - Fax:856-853-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000614452OtherIBC
NJ000786022001OtherUNITED HEALTHCARE
NJ6444407Medicaid
NJ10872OtherAETNA
NJ0762906002OtherAMERIHEALTH
NJ=========OtherAMERICHOICE
NJ=========OtherCIGNA
NJ=========OtherHEALTHNET
NJ=========OtherHORIZON NJ HEALTH
NJ=========OtherOXFORD
NJ6444407Medicaid
NJ000614452OtherIBC
NJ=========OtherHORIZON