Provider Demographics
NPI:1710972716
Name:RODRIGUEZ, MARINILDA
Entity Type:Individual
Prefix:DR
First Name:MARINILDA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90567
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-0567
Mailing Address - Country:US
Mailing Address - Phone:267-978-4747
Mailing Address - Fax:
Practice Address - Street 1:101 S 17TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6704
Practice Address - Country:US
Practice Address - Phone:484-664-2170
Practice Address - Fax:484-664-2171
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004807213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
PASC004807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50056100OtherCAPITAL BLUE CROSS
0123110OtherGHI
INDEPENDENCE BLUE CROther1763939
101450010 0001OtherMEDICAID
PA1014500100001Medicaid
1761920OtherHIGMARK BHLUE SHIELD
5669603OtherCIGNA
101450010 0001OtherMEDICAID
PA1014500100001Medicaid
0123110OtherGHI