Provider Demographics
NPI:1912913765
Name:RODGERS, ELIZABETH C (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:
Practice Address - Street 1:20 DANIEL SHAYS HWY
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9882
Practice Address - Country:US
Practice Address - Phone:413-323-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56245207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
056245OtherCONNECTICARE
056245OtherTUFTS COMM. HLTH PLAN
354650OtherHEALTHSOURCE CMHC
101968OtherCIGNA
65302OtherHARARD PILGRIM HC
04-01565OtherUNITED HEALTH CARE
984977OtherNETWORK HEALTH
MD3008002Medicaid
57287OtherFALLON COMMUNITY HLTH PLA
J07064OtherBCBS OF MA
MD3008002Medicaid
056245OtherCONNECTICARE