Provider Demographics
NPI:1164648135
Name:GEORGE L. RODRIGUEZ, M.D., P.C.
Entity Type:Organization
Organization Name:GEORGE L. RODRIGUEZ, M.D., P.C.
Other - Org Name:UNIVERSITY DYNAMIC MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-425-1500
Mailing Address - Street 1:1938 S COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2802
Mailing Address - Country:US
Mailing Address - Phone:215-462-1500
Mailing Address - Fax:215-462-2010
Practice Address - Street 1:1938 S COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2802
Practice Address - Country:US
Practice Address - Phone:215-462-1500
Practice Address - Fax:215-462-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
045575900OtherINDEPENDENCE BLUE CROSS/PERSONAL CHOICE
PA626086OtherHIGHMARK BLUE SHIELD
PA626086OtherHIGHMARK BLUE SHIELD