MEDICARE: MYRON RODOS DO

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	207Q00000X	Family Medicine Physician	0S002454L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275505919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRON RODOS DO

Provider Business Mailing Address
First Line	:	7515 STENTON AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-3710
Country	:	US
Telephone Number	:	215-763-9564
Fax Number	:	215-763-1165

Provider Business Practice Location Address
First Line	:	703 CECIL B MOORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2901
Country	:	US
Telephone Number	:	215-763-9564
Fax Number	:	215-763-1165

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/22/2026

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