Provider Demographics
NPI:1891797015
Name:RODRIGUEZ, DAISY A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:A
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 1:841 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2401
Mailing Address - Country:US
Mailing Address - Phone:215-425-1500
Mailing Address - Fax:215-425-1659
Practice Address - Street 1:841 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2401
Practice Address - Country:US
Practice Address - Phone:215-425-1500
Practice Address - Fax:215-425-1659
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-03-20
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
PAMD045274E207R00000X, 202C00000X
FLME73807207R00000X
NC9400621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE34912Medicare UPIN
PAE0283CJ1ZMedicare PIN