Provider Demographics
NPI:1598854390
Name:RODRIGUEZ, ALFONSO I (MD)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:I
Last Name:RODRIGUEZ
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 1:1130 HIGHWAY 315
Mailing Address - Street 2:
Mailing Address - City:WILKESBARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6952
Mailing Address - Country:US
Mailing Address - Phone:570-823-8896
Mailing Address - Fax:570-823-1291
Practice Address - Street 1:1130 HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:WILKESBARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6952
Practice Address - Country:US
Practice Address - Phone:570-823-8896
Practice Address - Fax:570-823-1291
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038750E207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001088784Medicaid
PA167750Medicare ID - Type Unspecified