# GEORGE L. RODRIGUEZ, M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** University Dynamic MRI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487871489
- **Authorized official:** ELLEN C. BAMBA (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (215) 425-1500

## Contact information

- **Practice address:** 2487 GRANT AVENUE, PHILADELPHIA, PA 19114
- **Practice address phone:** (215) 464-0150
- **Mailing address:** 2487 GRANT AVENUE, PHILADELPHIA, PA 19114
- **Mailing address phone:** (215) 464-0150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 06/23/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 045575900 | INDEPENDENCE BLUE CROSS/PERSONAL CHOICE | PA |
| 01 | — | 626086 | HIGHMARK BLUE SHIELD | PA |