Organization
GEORGE L. RODRIGUEZ, M.D., P.C.
Active
Other names
University Dynamic MRI
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN CAMPION BAMBA (PRACTICE ADMINISTRATOR)
(215) 425-1500
Entity
Organization
Contact information
Practice address
7632 CITY LINE AVE, PHILADELPHIA, PA 19151-2007
(215) 425-1500
(215) 425-1659
Mailing address
7632 CITY LINE AVE, PHILADELPHIA, PA 19151-2007
(215) 473-1500
(215) 473-5293
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
—
0455759000
INDEPENDENCE BLUE CROSS
PA
01
—
626086
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/17/2008
Last updated
06/23/2009
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