Provider Demographics
NPI:1801498621
Name:ROGERS, TUBAL C
Entity type:Individual
Prefix:MR
First Name:TUBAL
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 CHEVERS DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-2339
Mailing Address - Country:US
Mailing Address - Phone:484-515-0003
Mailing Address - Fax:
Practice Address - Street 1:4303 CHEVERS DR
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-2339
Practice Address - Country:US
Practice Address - Phone:484-515-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide