Provider Demographics
NPI:1982823035
Name:KING, RODERICK K (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:K
Last Name:KING
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:HRSA, RM 1826, JFK FED BUILDIN
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02203
Mailing Address - Country:US
Mailing Address - Phone:617-901-3045
Mailing Address - Fax:
Practice Address - Street 1:164 LONGWOOD AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5810
Practice Address - Country:US
Practice Address - Phone:617-901-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics