Provider Demographics
NPI:1720198146
Name:RODGERS, JOSEPH LEWIS JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEWIS
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1310
Mailing Address - Country:US
Mailing Address - Phone:401-885-8512
Mailing Address - Fax:
Practice Address - Street 1:66 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1522
Practice Address - Country:US
Practice Address - Phone:401-461-9110
Practice Address - Fax:401-461-9194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10279207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RID94286Medicare UPIN