Provider Demographics
NPI:1902851694
Name:RODRIGUE, STEPHEN WILFRED (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILFRED
Last Name:RODRIGUE
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 1:20 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1318
Mailing Address - Country:US
Mailing Address - Phone:207-781-4424
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1318
Practice Address - Country:US
Practice Address - Phone:207-781-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME15049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG64755OtherHARVARD PILGRIM HEALTHSOU
ME043319OtherANTHEM
ME260140099Medicaid
ME30202036OtherNH MEDICAID
ME2745463OtherAETNA HMO
ME200042914OtherRAILROAD MEDICARE
MEM153272OtherCIGNA HEALTHSOURCE
ME1120990001OtherDMERC
ME010507276OtherTAX ID
ME5909591OtherAETNA NON HMO
MEM153272OtherCIGNA HEALTHSOURCE