Healthcare Provider Details

I. General information

NPI: 1801419940
Provider Name (Legal Business Name): BRIAN DAVID ROGERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 07/13/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMG VILLAGE-MAIN 4830 RUCKER ROAD
MONETA VA
24121-5281
US

IV. Provider business mailing address

CMG VILLAGE-MAIN 4830 RUCKER ROAD
MONETA VA
24121-5281
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-7181
  • Fax: 540-297-6145
Mailing address:
  • Phone: 540-297-7181
  • Fax: 540-297-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberED0921A
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102207851
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: