Individual
DEIRDRE RODERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
159 WELLS AVE, NEWTON, MA 02459-3301
(617) 243-5777
Mailing address
300 1ST AVE, CHARLESTOWN, MA 02129-3109
(617) 952-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
267300
MA
208100000X
Physical Medicine & Rehabilitation Physician
125069738
IL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
290185
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
10/05/2021
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