Provider Demographics
NPI:1093786899
Name:RODIG, NANCY MACDONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MACDONALD
Last Name:RODIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 FEARING DR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2015
Mailing Address - Country:US
Mailing Address - Phone:781-329-5385
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6129
Practice Address - Fax:617-730-0569
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1571342080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3180689Medicaid
MA3180689Medicaid
G74500Medicare UPIN