MEDICARE: GEORGE L. RODRIGUEZ, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD 045274E	PA
2	207R00000X	Internal Medicine Physician
3	208100000X	Physical Medicine & Rehabilitation Physician	MD 036647E	PA
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD 036647E	PA
5	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0455759000	OTHER	PA	INDEPENDENCE BLUE CROSS
2	626086	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1205072550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE L. RODRIGUEZ, M.D., P.C.

Provider Business Mailing Address
First Line	:	841 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2401
Country	:	US
Telephone Number	:	215-425-1500
Fax Number	:	215-425-1659

Provider Business Practice Location Address
First Line	:	7632 CITY LINE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2007
Country	:	US
Telephone Number	:	215-473-1500
Fax Number	:	215-473-5293

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. ELLEN CAMPION BAMBA
Credential	:
Telephone Number	:	215-425-1500

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	06/24/2009

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