Provider Demographics
NPI:1558698811
Name:RODRIGUEZ THOMAS, EVELYN M (MD, MPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:M
Last Name:RODRIGUEZ THOMAS
Suffix:
Gender:F
Credentials:MD, MPH, MBA
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:M
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH, MBA
Mailing Address - Street 1:MCLEOD MEDICAL PARK
Mailing Address - Street 2:3980 HWY 9E, SUITE 100
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-1620
Mailing Address - Country:US
Mailing Address - Phone:843-273-0484
Mailing Address - Fax:866-452-6976
Practice Address - Street 1:MCLEOD MEDICAL PARK
Practice Address - Street 2:3980 HWY 9E, SUITE 100
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-1620
Practice Address - Country:US
Practice Address - Phone:843-273-0484
Practice Address - Fax:866-452-6976
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1617362084P0800X
SC908862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry