Provider Demographics
NPI:1073532214
Name:RELOVA, RODERICK M (DO)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:M
Last Name:RELOVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:123 STEFFENS BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9659
Mailing Address - Country:US
Mailing Address - Phone:302-331-4004
Mailing Address - Fax:302-698-9296
Practice Address - Street 1:13 FALLON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1577
Practice Address - Country:US
Practice Address - Phone:302-629-7177
Practice Address - Fax:302-629-7677
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH0064703207L00000X
TXU1450207L00000X
DEC2-0004565207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00127343OtherRAILROAD MEDICARE
DEG01399D99Medicare PIN