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Organization
GEORGE L. RODRIGUEZ, M.D., P.C.
Active
Organization
GEORGE L. RODRIGUEZ, M.D., P.C.
Active
Other names
University Dynamic MRI
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN C BAMBA (ADMINISTRATIVE DIRECTOR)
(215) 425-1500
Entity
Organization
Contact information
Practice address
1938 S COLUMBUS BLVD, PHILADELPHIA, PA 19148-2802
(215) 462-1500
(215) 462-2010
Mailing address
1938 S COLUMBUS BLVD, PHILADELPHIA, PA 19148-2802
(215) 462-1500
(215) 462-2010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045575900
INDEPENDENCE BLUE CROSS/PERSONAL CHOICE
—
01
—
626086
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/18/2007
Last updated
06/24/2009
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