Provider Demographics
NPI:1598865149
Name:RODRIGUEZ, MARIA DOLORES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DOLORES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2101
Mailing Address - Country:US
Mailing Address - Phone:718-945-7150
Mailing Address - Fax:718-945-2596
Practice Address - Street 1:11811 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2101
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-945-2596
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00382247Medicaid
NY06596Medicare ID - Type Unspecified
NY00382247Medicaid