Healthcare Provider Details

I. General information

NPI: 1346248580
Provider Name (Legal Business Name): THOMAS EDWARD RODGERSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 HARFORD RD
PARKVILLE MD
21234-5888
US

IV. Provider business mailing address

14616 JAYSTONE DR
SILVER SPRING MD
20905-7405
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-1988
  • Fax: 410-882-1898
Mailing address:
  • Phone: 301-388-2535
  • Fax: 301-388-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0154
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: