Provider Demographics
NPI:1922023597
Name:ROGERS, CHRISTOPHER DAVID (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3388
Mailing Address - Country:US
Mailing Address - Phone:252-337-9440
Mailing Address - Fax:252-384-9997
Practice Address - Street 1:1177 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3388
Practice Address - Country:US
Practice Address - Phone:252-337-9440
Practice Address - Fax:252-384-9997
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1177208600000X
NC2016-01129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME299810099Medicaid
ME299810099Medicaid
E70711Medicare UPIN