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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 CAMPION BAMBA (PRACTICE ADMINISTRATOR)
(215) 425-1500
Entity
Organization
Contact information
Practice address
7632 CITY LINE AVE, PHILADELPHIA, PA 19151-2007
(215) 425-1500
(215) 425-1659
Mailing address
7632 CITY LINE AVE, PHILADELPHIA, PA 19151-2007
(215) 473-1500
(215) 473-5293
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
—
0455759000
INDEPENDENCE BLUE CROSS
PA
01
—
626086
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/17/2008
Last updated
06/23/2009
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