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NPI Code Detail

MEDICARE: DAVID J RODAK M.D.

MEDICARE: DAVID J RODAK M.D.
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
1207RC0001XClinical Cardiac Electrophysiology Physician18869SC
2207RC0000XCardiovascular Disease Physician18869SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
170193OTHERMEDCOST PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
45013113OTHERAETNA PIN

General Provider Information

NPI Number : 1215983887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID J RODAK M.D.
Provider Business Mailing Address
First Line : 1083 BOILING SPRINGS RD
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-2248
Country : US
Telephone Number : 864-583-8647
Fax Number : 864-542-2227
Provider Business Practice Location Address
First Line : 1083 BOILING SPRINGS RD
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-2248
Country : US
Telephone Number : 864-583-8647
Fax Number : 864-542-2227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 04/08/2026

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