Provider Demographics
NPI:1326137845
Name:RODRIGUEZ, BARTHOLOME (MD)
Entity Type:Individual
Prefix:
First Name:BARTHOLOME
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 1:631 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2801
Mailing Address - Country:US
Mailing Address - Phone:718-324-3100
Mailing Address - Fax:
Practice Address - Street 1:631 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2801
Practice Address - Country:US
Practice Address - Phone:718-324-3100
Practice Address - Fax:718-994-3083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY-159701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01157368Medicaid
NY01157368Medicaid
NY27F562Medicare ID - Type Unspecified