Healthcare Provider Details

I. General information

NPI: 1629071741
Provider Name (Legal Business Name): GILBERTO E RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SENTRY PKWY E STE 200
BLUE BELL PA
19422-2324
US

IV. Provider business mailing address

470 SENTRY PKWY E STE 200
BLUE BELL PA
19422-2324
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-5800
  • Fax: 610-397-0980
Mailing address:
  • Phone: 610-825-5800
  • Fax: 610-397-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD010397E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: