Healthcare Provider Details

I. General information

NPI: 1093058620
Provider Name (Legal Business Name): ENRIQUE RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 NEWMAN RD
NEW BERN NC
28562-5238
US

IV. Provider business mailing address

801 ARCANE CIR
NEW BERN NC
28562-7310
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-5057
  • Fax: 252-633-0084
Mailing address:
  • Phone: 305-283-8610
  • Fax: 252-633-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2019-00709
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2019-00709
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101289242
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101289242
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301103074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: