Provider Demographics
NPI:1568552917
Name:OUANO, RODOLFO C (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:C
Last Name:OUANO
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 1:1872 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2558
Mailing Address - Country:US
Mailing Address - Phone:732-727-7470
Mailing Address - Fax:732-525-2204
Practice Address - Street 1:1872 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2558
Practice Address - Country:US
Practice Address - Phone:732-727-7470
Practice Address - Fax:732-525-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA26673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP841935OtherOXFORD PROVIDER ID
NJC53630Medicare UPIN
NJ157247Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER