Healthcare Provider Details

I. General information

NPI: 1477804433
Provider Name (Legal Business Name): RAFAEL DURAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAFAEL DURAN

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 09/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE JOHNS HOPKINS HOSPITAL SHEIKH ZAYED TOWER, SUITE 7203, 1800 ORLEANS STREET,
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

2832 SAINT PAUL ST
BALTIMORE MD
21218-4311
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-2227
  • Fax: 410-955-0233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP28227
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberP28227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: