Healthcare Provider Details

I. General information

NPI: 1487871489
Provider Name (Legal Business Name): GEORGE L. RODRIGUEZ, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 GRANT AVENUE
PHILADELPHIA PA
19114
US

IV. Provider business mailing address

2487 GRANT AVENUE
PHILADELPHIA PA
19114
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-0150
  • Fax:
Mailing address:
  • Phone: 215-464-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELLEN C. BAMBA
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 215-425-1500