Provider Demographics
NPI:1093816969
Name:RODIN, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:RODIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3106
Mailing Address - Country:US
Mailing Address - Phone:203-755-0163
Mailing Address - Fax:203-753-3415
Practice Address - Street 1:1211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3106
Practice Address - Country:US
Practice Address - Phone:203-755-0163
Practice Address - Fax:203-753-3415
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040418202C00000X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001404186Medicaid
CT040418OtherCONNECTICARE
CT2V2068OtherHEALTHNET
CTP2679357OtherOXFORD
CT2522042OtherUNITED HC
CT010040418CT01OtherANTHEM BCBS
CT001404186Medicaid
CTP2679357OtherOXFORD
CT040418OtherCONNECTICARE