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NPI Code Detail

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

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 License Number License Number State
12085R0202XDiagnostic Radiology Physician
2208100000XPhysical Medicine & Rehabilitation Physician
3207R00000XInternal Medicine Physician
4261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10455759000OTHERPAINDEPENDENCE BLUE CROSS
2626086OTHERPAHIGHMARK BLUE SHIELD

General Provider Information

NPI Number : 1922244235
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE L. RODRIGUEZ, M.D., P.C.
Provider Business Mailing Address
First Line : 7632 CITY LINE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-2007
Country : US
Telephone Number : 215-473-1500
Fax Number : 215-473-5293
Provider Business Practice Location Address
First Line : 7632 CITY LINE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-2007
Country : US
Telephone Number : 215-425-1500
Fax Number : 215-425-1659
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : ELLEN CAMPION BAMBA
Credential :
Telephone Number : 215-425-1500
Provider Enumeration Date : 12/17/2008
Last Update Date : 06/23/2009

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