Provider Demographics
NPI:1720016389
Name:CARTAGENA, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:CARTAGENA
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0306
Mailing Address - Country:US
Mailing Address - Phone:768-883-5050
Mailing Address - Fax:276-565-2427
Practice Address - Street 1:127 CALLAHAN AVE
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216-1203
Practice Address - Country:US
Practice Address - Phone:276-565-2425
Practice Address - Fax:276-565-2427
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028013207R00000X, 207VG0400X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720016389Medicaid
VA010255325Medicaid
VAP00439706Medicare PIN
VA1720016389Medicaid
VA015077W82Medicare PIN