Provider Demographics
NPI:1629418322
Name:RODES, DEBORAH B (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:B
Last Name:RODES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 HARBOR CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3203
Mailing Address - Country:US
Mailing Address - Phone:516-220-3095
Mailing Address - Fax:516-674-7639
Practice Address - Street 1:658 HARBOR CREEK PL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3203
Practice Address - Country:US
Practice Address - Phone:516-220-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine