Healthcare Provider Details

I. General information

NPI: 1821772955
Provider Name (Legal Business Name): MARIA CAROLINA RODRIGUEZ DOMINGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date: 01/12/2024
Reactivation Date: 02/02/2024

III. Provider practice location address

10 BENTON AVE
MIDDLETOWN NY
10940-5177
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-8000
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number345486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: