Provider Demographics
NPI:1891812590
Name:RODRIGUEZ, ADOLFO MIGUEL (PHD)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:MIGUEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 OAK HILL CT
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6747
Mailing Address - Country:US
Mailing Address - Phone:410-552-9904
Mailing Address - Fax:410-549-7650
Practice Address - Street 1:2200 OAK HILL CT
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6747
Practice Address - Country:US
Practice Address - Phone:410-552-9904
Practice Address - Fax:410-549-7650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03163103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist