Provider Demographics
NPI:1558649681
Name:RODRIGO, NIMALIE (MD)
Entity Type:Individual
Prefix:
First Name:NIMALIE
Middle Name:
Last Name:RODRIGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIMALIE
Other - Middle Name:
Other - Last Name:RANASINGHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:CBO
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2923
Mailing Address - Fax:
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-373-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443244207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology