Provider Demographics
NPI:1649156290
Name:ROGERS, CORNELIUS SR
Entity type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:
Last Name:ROGERS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-1843
Mailing Address - Country:US
Mailing Address - Phone:234-716-4269
Mailing Address - Fax:
Practice Address - Street 1:1223 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1843
Practice Address - Country:US
Practice Address - Phone:234-716-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRQ103862172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver