Basic Information
| Provider Information | |||||||||
| NPI: | 1790745560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 N POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172994871 | ||||||||
| FaxNumber: | 7173912494 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 N POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172994871 | ||||||||
| FaxNumber: | 7173912494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | MD049880L | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207X00000X | MD049880L | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0633977 | 01 | PA | BLUE SHIELD | OTHER | 0015125310008 | 05 | PA | MEDICAID | 259765 | 01 | PA | HEALTHAMERICA/HEALTHASSUR | OTHER | 3268500 | 01 | PA | BLUE CROSS | OTHER | 1148532 | 01 | PA | AETNA | OTHER | 20014846 | 01 | PA | AMERIHEALTHMERCY | OTHER |