Provider Demographics
NPI:1023052826
Name:ROGERS, CHARLES ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6966 POMAIKAI ST
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-9354
Mailing Address - Country:US
Mailing Address - Phone:808-823-0676
Mailing Address - Fax:
Practice Address - Street 1:3367 KUHIO HWY
Practice Address - Street 2:KAUAI COMMUNITY BASED OUTPATIENT CLINIC
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-246-0497
Practice Address - Fax:808-246-9349
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161660-1 EXPIRED207Q00000X
HIMD-60762084P0800X
FLME 824432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry