Provider Demographics
NPI:1538275102
Name:ROGERS, BRAD S (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CAPITAL WAY
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-303-4460
Mailing Address - Fax:609-303-4461
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:SUITE 407
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-303-4460
Practice Address - Fax:609-303-4461
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD032465E208800000X
NJNJ25MA04055000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0505307Medicaid
NJ0505307Medicaid
C54023Medicare UPIN