Healthcare Provider Details

I. General information

NPI: 1952370249
Provider Name (Legal Business Name): MIGUEL A. RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 MAIN STREET
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

2150 MAIN STREET STE 265 HOSPITALIST OFFICE
SPRINGFIELD MA
01104
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5676
  • Fax: 413-739-2278
Mailing address:
  • Phone: 413-739-5676
  • Fax: 413-739-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number220411
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA-220411
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: