Organization
GEORGE L. RODRIGUEZ, M.D., P.C.
Active
Other names
Advanced Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELLEN C. BAMBA (PRACTICE ADMINISTRATOR)
(215) 425-1500
Entity
Organization
Contact information
Practice address
1938 S COLUMBUS BLVD, PHILADELPHIA, PA 19148-2802
(215) 462-1500
(215) 462-2010
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
208100000X
Physical Medicine & Rehabilitation Physician
MD 036647E
PA
2085R0202X
Diagnostic Radiology Physician
131553-1 - NY
NY
2085R0202X
Diagnostic Radiology Physician
155494-1 - NY
NY
2085R0202X
Diagnostic Radiology Physician
MD 039238-E
PA
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
03/19/2009
Last updated
06/24/2009
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