Healthcare Provider Details

I. General information

NPI: 1578738506
Provider Name (Legal Business Name): CHARLES GILBERT ZIMBRICK-ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES GILBERT ROGERS III M.D.

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FORREST AVE STE 15
NARBERTH PA
19072-2219
US

IV. Provider business mailing address

107 FORREST AVE STE 15
NARBERTH PA
19072-2219
US

V. Phone/Fax

Practice location:
  • Phone: 267-521-2476
  • Fax:
Mailing address:
  • Phone: 267-300-5373
  • Fax: 844-913-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD443117
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMD443117
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD443117
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number337177-01
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number337177-01
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA10691300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number25MA10691300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: