Provider Demographics
NPI:1487661237
Name:FERNANDEZ, RODOLFO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ENRIQUE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:724 MAIDEN CHOICE LN
Mailing Address - Street 2:STE 202
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5963
Mailing Address - Country:US
Mailing Address - Phone:410-747-6080
Mailing Address - Fax:410-747-3495
Practice Address - Street 1:724 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5911
Practice Address - Country:US
Practice Address - Phone:410-747-6080
Practice Address - Fax:410-747-3495
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0050303207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD090788000Medicaid
MDG32011Medicare UPIN