Provider Demographics
NPI:1942606074
Name:ARCILLA, RHODORA M (MD)
Entity Type:Individual
Prefix:
First Name:RHODORA
Middle Name:M
Last Name:ARCILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHODORA
Other - Middle Name:MALICDEM
Other - Last Name:ARCILLAPETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1551 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2313
Mailing Address - Country:US
Mailing Address - Phone:718-987-4891
Mailing Address - Fax:
Practice Address - Street 1:1551 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2313
Practice Address - Country:US
Practice Address - Phone:718-987-4891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281949207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY281949OtherMEDICAL LICENSE