Individual
FABIAN D RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15105 SAINT CLAIR AVE, CLEVELAND, OH 44110-3719
(216) 800-8020
(216) 830-7652
Mailing address
15105 SAINT CLAIR AVE, CLEVELAND, OH 44110-3719
(216) 800-8020
(216) 830-7652
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.145971
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149VT
BCBS NC
NC
01
—
1801855192
MEDCOST PROVIDER #
—
05
—
5909786
—
NC
01
—
FH1100395
FIRSTCAROLINACARE
NC
01
—
N01727
SOUTH CAROLINA MEDICAID
SC
01
—
P00618615
PALMETTO GBA PROVIDER #
—
Enumeration date
03/23/2006
Last updated
09/06/2022
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