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
2487 GRANT AVENUE, PHILADELPHIA, PA 19114
(215) 464-0150
Mailing address
2487 GRANT AVENUE, PHILADELPHIA, PA 19114
(215) 464-0150
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
PA
01
—
626086
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/19/2007
Last updated
06/23/2009
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