MEDICARE: MARINA F 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	207R00000X	Internal Medicine Physician	MD05820	RI

General Provider Information

NPI Number	:	1417955071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA F RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	17 VIRGINIA AVE
Second Line	:	SUITE 107
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-4406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 WAMPANOAG TRL
Second Line	:	SUITE 201
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-2212
Country	:	US
Telephone Number	:	401-649-4020
Fax Number	:	401-649-4021

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	06/13/2016

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