Provider Demographics
NPI:1457395907
Name:ROGERS, CHARLES STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEWART
Last Name:ROGERS
Suffix:
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3948
Mailing Address - Fax:336-832-8641
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-8062
Practice Address - Fax:336-832-8641
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7012278OtherAETNA
NC8972930Medicaid
NC47355OtherMEDCOST
NC72930OtherBCBS NC
NC19283OtherPARTNERS MEDICARE CHOICE
NC19283OtherPARTNERS MEDICARE CHOICE
NC7012278OtherAETNA