Provider Demographics
NPI:1396841235
Name:MARTHA M RODRIGUEZ MD PA
Entity Type:Organization
Organization Name:MARTHA M RODRIGUEZ MD PA
Other - Org Name:MARTHA M RODRIGUEZ MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-364-8056
Mailing Address - Street 1:2015 OCEAN DR
Mailing Address - Street 2:STE 11
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5131
Mailing Address - Country:US
Mailing Address - Phone:561-364-8056
Mailing Address - Fax:561-364-8507
Practice Address - Street 1:2015 OCEAN DR
Practice Address - Street 2:STE 11
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5131
Practice Address - Country:US
Practice Address - Phone:561-364-8056
Practice Address - Fax:561-364-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF96629Medicare UPIN
FLAL570Medicare PIN