Individual
DR. MARINILDA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S 17TH ST, ALLENTOWN, PA 18104-6704
(484) 664-2170
(484) 664-2171
Mailing address
PO BOX 90567, ALLENTOWN, PA 18109-0567
(267) 978-4747
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
SC004807
PA
213EP1101X
Primary Podiatric Medicine Podiatrist
SC-004807
PA
213ER0200X
Radiology Podiatrist
SC-004807
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC-004807
PA
213ES0131X
Foot Surgery Podiatrist
SC-004807
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123110
GHI
—
01
—
101450010 0001
MEDICAID
—
05
—
1014500100001
—
PA
01
—
1761920
HIGMARK BHLUE SHIELD
—
01
—
50056100
CAPITAL BLUE CROSS
—
01
—
5669603
CIGNA
—
01
—
INDEPENDENCE BLUE CR
1763939
—
Enumeration date
09/15/2005
Last updated
04/15/2008
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