Provider Demographics
NPI:1053312710
Name:ROGERS, JOSHUA B (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
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 1:5005 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3107
Mailing Address - Country:US
Mailing Address - Phone:804-201-1794
Mailing Address - Fax:
Practice Address - Street 1:7100 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-483-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12876207P00000X
CAA105542207P00000X
VA0101238084207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053312710Medicaid
CA1053312710Medicaid
NV1053312710Medicaid
CA1053312710Medicare PIN
NV1053312710Medicaid
VA021187V21Medicare PIN
NV1053312710Medicare PIN
VA021714V20Medicare PIN