Provider Demographics
NPI:1821053166
Name:RODOWICZ, KEVIN F (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:F
Last Name:RODOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:ENROLLMENT CENTER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-398-2600
Mailing Address - Fax:610-398-0240
Practice Address - Street 1:3560 ROUTE 309
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2001
Practice Address - Country:US
Practice Address - Phone:610-398-2600
Practice Address - Fax:610-398-0240
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009787L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017513610001Medicaid
PA0017513610001Medicaid
PAG89772Medicare UPIN