Provider Demographics
NPI:1386899078
Name:ROGERS, ETHAN SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:SAMUEL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 OSLER DR
Mailing Address - Street 2:BUILDING A, SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7733
Mailing Address - Country:US
Mailing Address - Phone:410-427-5510
Mailing Address - Fax:
Practice Address - Street 1:7501 OSLER DR
Practice Address - Street 2:BUILDING A, SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7733
Practice Address - Country:US
Practice Address - Phone:410-427-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019537208600000X
MDD76143208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery