MEDICARE: GEORGE L. RODRIGUEZ, M.D., P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208100000X	Physical Medicine & Rehabilitation Physician
2	207R00000X	Internal Medicine Physician
3	2085R0202X	Diagnostic Radiology Physician
4	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045575900	OTHER	PA	INDEPENDENCE BLUE CROSS/PERSONAL CHOICE
2	626086	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1487871489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE L. RODRIGUEZ, M.D., P.C.

Provider Business Mailing Address
First Line	:	2487 GRANT AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114
Country	:	US
Telephone Number	:	215-464-0150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2487 GRANT AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114
Country	:	US
Telephone Number	:	215-464-0150
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	ELLEN C. BAMBA
Credential	:
Telephone Number	:	215-425-1500

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	06/23/2009

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