Healthcare Provider Details

I. General information

NPI: 1528497203
Provider Name (Legal Business Name): RODICA GAVRILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RODICA RAILEANU MD

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S MYRTLE AVE
WILLARD OH
44890-1408
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-0187
  • Fax: 419-935-0200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35122553
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number54793-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: