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NPI Code Detail

MEDICARE: GEORGE L. RODRIGUEZ, M.D., PC

MEDICARE: GEORGE L. RODRIGUEZ, M.D., PC
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1045575900OTHERPAINDEPENDENCE BLUE CROSS

General Provider Information

NPI Number : 1184041162
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE L. RODRIGUEZ, M.D., PC
Provider Business Mailing Address
First Line : 841 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-2401
Country : US
Telephone Number : 215-473-1500
Fax Number : 215-473-4606
Provider Business Practice Location Address
First Line : 7632 CITY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-2007
Country : US
Telephone Number : 215-473-1500
Fax Number : 215-473-1500
Authorized Official
Title or Position : ADMINISTRATIVE DIRECTOR
Name : SIDNEY ZILBER
Credential :
Telephone Number : 215-473-1500
Provider Enumeration Date : 03/27/2014
Last Update Date : 03/27/2014

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