Healthcare Provider Details

I. General information

NPI: 1871696401
Provider Name (Legal Business Name): CHRISTINE A. RODGERS RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BUFFALO RD
NORTH CHILI NY
14514-1256
US

IV. Provider business mailing address

PO BOX 505
NORTH CHILI NY
14514-0505
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-5995
  • Fax: 585-594-5425
Mailing address:
  • Phone: 585-594-5995
  • Fax: 585-594-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: