Provider Demographics
NPI:1477539823
Name:RODES, ALFREDO M (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:M
Last Name:RODES
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 1:640 ELLICOTT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1245
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-235-2636
Practice Address - Street 1:640 ELLICOTT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1245
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-235-2636
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010199503OtherUNIVERA
NY403066OtherWELLCARE
NY01670020Medicaid
NY145837BJOtherPREFERRED CARE
NY040426035668OtherFIDELIS
NY0408448OtherIHA
NY000524430006OtherBC/BS
G31046Medicare UPIN
NY145837BJOtherPREFERRED CARE
NY01670020Medicaid