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1063493914

NPI Code Detail

MEDICARE: DR. LEONEL A RODRIGUEZ MD

MEDICARE: DR. LEONEL A RODRIGUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	64286	CT
2	208000000X	Pediatrics Physician	64286	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468756	OTHER	MA	TUFTS HEALTH PLAN
2	J27116	OTHER	MA	BCBS MA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063493914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONEL A RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	333 CEDAR ST LMP# 4093
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3206
Country	:	US
Telephone Number	:	203-785-4649
Fax Number	:	203-737-1384

Provider Business Practice Location Address
First Line	:	1 PARK ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06504-8901
Country	:	US
Telephone Number	:	203-785-4649
Fax Number	:	203-737-1384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	09/30/2019

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Directions to “ DR. LEONEL A RODRIGUEZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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