Provider Demographics
NPI:1609627231
Name:ROGERS, WILLARD BLAINE (MBA)
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:BLAINE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 CAMBRIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2531
Mailing Address - Country:US
Mailing Address - Phone:443-769-3969
Mailing Address - Fax:571-699-2950
Practice Address - Street 1:720 CAMBRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2531
Practice Address - Country:US
Practice Address - Phone:443-769-3969
Practice Address - Fax:571-699-2950
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome Health