# GEORGE L RODRIGUEZ MD PC

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

## Provider details

- **NPI number:** 1912134842
- **Authorized official:** MS. ELLEN C. BAMBA (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (215) 425-1500

## Contact information

- **Practice address:** 1326 MACDADE BLVD, WOODLYN, PA 19094-1500
- **Practice address phone:** (215) 425-1500
- **Practice address fax:** (215) 425-1659
- **Mailing address:** 841 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-2401
- **Mailing address phone:** (215) 425-1500
- **Mailing address fax:** (215) 425-1659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD 045274E | PA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD 036647E | PA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD-025907 | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | 131553-1 - NY | NY | — |
| 2085R0202X | Diagnostic Radiology Physician | 155494-1 - NY | NY | — |
| 2085R0202X | Diagnostic Radiology Physician | MD 039238-E | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | MD 072988L | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | MD067042L | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | MD422104 | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | MD435786 | PA | — |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2009
- **Last updated:** 06/24/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0455759000 | INDEPENDENCE BLUE CROSS | PA |
| 01 | — | 626086 | HIGHMARK BLUE SHIELD | PA |