Organization
GEORGE L RODRIGUEZ MD PC
Active
Other names
Injury Rehabilitation Centers of Pennsylvania
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN C BAMBA (ADMINISTRATIVE DIRECTOR)
(215) 425-1500
Entity
Organization
Contact information
Practice address
8 W BROOKHAVEN RD, SUITE B, BROOKHAVEN, PA 19015-1629
(610) 872-2642
(215) 425-1659
Mailing address
841 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-2401
(215) 425-1500
(215) 425-1659
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD 045274E
PA
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
MD 036647E
PA
208100000X
Physical Medicine & Rehabilitation Physician
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
05/10/2007
Last updated
06/24/2009
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