Healthcare Provider Details

I. General information

NPI: 1770824377
Provider Name (Legal Business Name): WILLIAM JULIO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE BLDG 32 ROOM 5162
SILVER SPRING MD
20993-0002
US

IV. Provider business mailing address

10903 NEW HAMPSHIRE BLDG 32 ROOM 5162
SILVER SPRING MD
20993-0002
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-8652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0031351
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: