Healthcare Provider Details

I. General information

NPI: 1316382484
Provider Name (Legal Business Name): RHODE BADIO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 CHEWS LANDING RD
CLEMENTON NJ
08021-2808
US

IV. Provider business mailing address

163 BRIDGETON PIKE
MULLICA HILL NJ
08062-2669
US

V. Phone/Fax

Practice location:
  • Phone: 856-545-9500
  • Fax: 856-221-4288
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-221-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00608000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: