Provider Demographics
NPI:1821000555
Name:RODRIGUEZ, GLOTI MARITA (MD)
Entity Type:Individual
Prefix:
First Name:GLOTI
Middle Name:MARITA
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 1:5278 DAWES AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1404
Mailing Address - Country:US
Mailing Address - Phone:703-671-3185
Mailing Address - Fax:703-671-9285
Practice Address - Street 1:5278 DAWES AVENUE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-671-3185
Practice Address - Fax:703-671-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006732551Medicaid
VA283317OtherAMERIGROUP MEDICAID
VA234981OtherHEALTH KEEPERS PLUS MEDIC
VA283317OtherAMERIGROUP MEDICAID
VA234981OtherHEALTH KEEPERS PLUS MEDIC