Healthcare Provider Details

I. General information

NPI: 1811807191
Provider Name (Legal Business Name): TIMOTHY WILLIAM RODRIGUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0010-17046
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: