MEDICARE: MR. CORNELIUS ROGERS SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	RQ103862	OH

General Provider Information

NPI Number	:	1649156290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORNELIUS ROGERS SR.

Provider Business Mailing Address
First Line	:	1223 ATWOOD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-1843
Country	:	US
Telephone Number	:	234-716-4269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 ATWOOD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-1843
Country	:	US
Telephone Number	:	234-716-4269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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