Healthcare Provider Details

I. General information

NPI: 1346959939
Provider Name (Legal Business Name): TIMOTHY RYAN RODGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 OPAL CT
HAGERSTOWN MD
21740-5934
US

IV. Provider business mailing address

10726 LIBERTY RD
FREDERICK MD
21701-2630
US

V. Phone/Fax

Practice location:
  • Phone: 301-703-9923
  • Fax:
Mailing address:
  • Phone: 301-703-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: