Provider Demographics
NPI:1144780594
Name:RODRIGUEZ, OLAF (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAF
Middle Name:
Last Name:RODRIGUEZ
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:DEPT OF DERMATOLOGY, UNIV OF PENNSYLVANIA HEALTH SYSTEM
Mailing Address - Street 2:3600 SPRUCE STREET, 2 MALONEY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF DERMATOLOGY, UNIV OF PENNSYLVANIA HEALTH SYSTEM
Practice Address - Street 2:3600 SPRUCE STREET, 2 MALONEY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4211
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT218605207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology