Provider Demographics
NPI:1821047473
Name:ROGERS, TONI DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:DENISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:DENISE
Other - Last Name:SUBLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4333 PINE TREE PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-5124
Mailing Address - Country:US
Mailing Address - Phone:937-408-6605
Mailing Address - Fax:937-390-1479
Practice Address - Street 1:3371 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2514
Practice Address - Country:US
Practice Address - Phone:937-384-4841
Practice Address - Fax:937-522-7626
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2089494Medicaid
OH000000570544OtherANTHEM-COMMUNITY
OH000000559820OtherANTHEM FAYETTE
OH000000559820OtherANTHEM FAYETTE
OH2089494Medicaid
OHRO0864577Medicare PIN
OHP00611223Medicare PIN
OHG64661Medicare UPIN
OH0864575Medicare PIN