Healthcare Provider Details

I. General information

NPI: 1720198146
Provider Name (Legal Business Name): JOSEPH LEWIS RODGERS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 PAVILION AVE
PROVIDENCE RI
02905-1522
US

IV. Provider business mailing address

1463 FRENCHTOWN RD
EAST GREENWICH RI
02818-1310
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-9110
  • Fax: 401-461-9194
Mailing address:
  • Phone: 401-885-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD10279
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: