Healthcare Provider Details

I. General information

NPI: 1730276791
Provider Name (Legal Business Name): DAVID RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W EMBARGO ST
ROME NY
13440-5047
US

IV. Provider business mailing address

204 BETSINGER RD APT 5
SHERRILL NY
13461-1502
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-4150
  • Fax: 315-339-4604
Mailing address:
  • Phone: 315-363-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number113076-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: