Provider Demographics
NPI:1922127950
Name:ROGERS, MARK BRANDON (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRANDON
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7017
Mailing Address - Country:US
Mailing Address - Phone:540-443-7180
Mailing Address - Fax:540-443-7182
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-443-7180
Practice Address - Fax:540-443-7182
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201857207QS0010X
NC116912207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA309761OtherANTHEM
G93823Medicare UPIN
VA014564A18Medicare PIN
VA309761OtherANTHEM