Healthcare Provider Details

I. General information

NPI: 1457325466
Provider Name (Legal Business Name): TINA CHRISTIANE RODRIGUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 200A
HAMPTON VA
23666-5975
US

IV. Provider business mailing address

4000 COLISEUM DR STE 200A
HAMPTON VA
23666-5975
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-1520
  • Fax:
Mailing address:
  • Phone: 757-736-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101241157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: