Provider Demographics
NPI:1114038999
Name:RODRIGUEZ, BARBARA MATILDE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MATILDE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:STE 204
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3445
Mailing Address - Country:US
Mailing Address - Phone:440-357-6740
Mailing Address - Fax:440-350-0506
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:STE 204
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3445
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-350-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048693R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0612886Medicaid
OH0612886Medicaid
OHA 16245Medicare UPIN