Healthcare Provider Details

I. General information

NPI: 1528008596
Provider Name (Legal Business Name): THOMAS PAUL RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 MAPLE ST SUITE 1
BIG FLATS NY
14814
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-562-8901
  • Fax: 607-562-7443
Mailing address:
  • Phone: 607-271-2050
  • Fax: 607-873-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173551
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number173351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: