Healthcare Provider Details

I. General information

NPI: 1932340056
Provider Name (Legal Business Name): GEORGE L. RODRIGUEZ, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 GRANT AVE
PHILADELPHIA PA
19114-1004
US

IV. Provider business mailing address

841 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-0150
  • Fax: 215-464-0174
Mailing address:
  • Phone: 215-425-1500
  • Fax: 215-425-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 045274E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD 036647E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number131553-1 - NY
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number155494-1 - NY
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD 039238-E
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELLEN C. BAMBA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 214-525-1500