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General NPI Number Information
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NPI Number | 1083997456
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Entity Type | Individual
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Provider Name | STACY L FERNANDEZ-RODRIGUE MD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 1316 W ONTARIO ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5220
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Country | US
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Telephone | 267-294-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 808 AUTUMN RIVER RUN
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4360
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Country | US
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Telephone | 504-460-6278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT 200248
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License Number State | PA
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