Provider Demographics
NPI:1578744793
Name:RODNEY S IANCOVICI MD PC
Entity Type:Organization
Organization Name:RODNEY S IANCOVICI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:SIMION
Authorized Official - Last Name:IANCOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-807-9400
Mailing Address - Street 1:PO BOX 6643
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-6643
Mailing Address - Country:US
Mailing Address - Phone:480-807-9400
Mailing Address - Fax:480-807-7946
Practice Address - Street 1:7516 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-8332
Practice Address - Country:US
Practice Address - Phone:480-807-9400
Practice Address - Fax:480-807-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ 76620Medicare PIN