Healthcare Provider Details

I. General information

NPI: 1891797015
Provider Name (Legal Business Name): DAISY A RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date: 03/31/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

841 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

IV. Provider business mailing address

841 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-1500
  • Fax: 215-425-1659
Mailing address:
  • Phone: 215-425-1500
  • Fax: 215-425-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD045274E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberMD045274E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME73807
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9400621
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: