Provider Demographics
NPI:1770248700
Name:ROGERS, DONOVAN P (QMHS)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:P
Last Name:ROGERS
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2802
Mailing Address - Country:US
Mailing Address - Phone:330-630-5600
Mailing Address - Fax:330-630-5810
Practice Address - Street 1:32 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2802
Practice Address - Country:US
Practice Address - Phone:330-630-5600
Practice Address - Fax:330-630-5600
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health