Provider Demographics
NPI:1346245057
Name:RODAK, ROBERT R (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:RODAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 PEPPER CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6445 PEPPER CT
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2673
Practice Address - Country:US
Practice Address - Phone:814-877-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006912L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5656066OtherAETNA
PAP000425OtherGATEWAY
PAP00170524OtherRR MEDICARE
PA0012375610010Medicaid
PA667203OtherBLUE SHIELD
PA159426OtherUNISON
PA208212OtherUPMC
NY00025557402OtherUNIVERA
PA5656066OtherAETNA
PA159426OtherUNISON