Healthcare Provider Details

I. General information

NPI: 1568653608
Provider Name (Legal Business Name): GILBERTO RODRIGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NEW WAVERLY PLACE SUITE 200
CARY NC
27518
US

IV. Provider business mailing address

550 NEW WAVERLY PL STE 200
CARY NC
27518-7412
US

V. Phone/Fax

Practice location:
  • Phone: 919-467-5941
  • Fax: 919-277-2043
Mailing address:
  • Phone: 919-467-5941
  • Fax: 919-277-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-123903
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number045457
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: