Healthcare Provider Details

I. General information

NPI: 1417909839
Provider Name (Legal Business Name): RAUL RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPITZ BLVD
WOODBRIDGE VA
22191-3311
US

IV. Provider business mailing address

PO BOX 75567
BALTIMORE MD
21275-5567
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-1313
  • Fax: 800-536-8431
Mailing address:
  • Phone: 888-898-3291
  • Fax: 800-536-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101031389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: