Provider Demographics
NPI:1740255710
Name:RODRIGUEZ, HUGO MOISES (M D)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:MOISES
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 ROSE FAMILY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4186
Mailing Address - Country:US
Mailing Address - Phone:804-971-8312
Mailing Address - Fax:
Practice Address - Street 1:411 W RANDOLPH RD
Practice Address - Street 2:JOHN RANDOPH MEDICAL CENTER
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2938
Practice Address - Country:US
Practice Address - Phone:804-524-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232037208M00000X, 207R00000X
FLME111859207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211387Medicaid
VABR7568908OtherDEA NUMBER
VAH52062Medicare UPIN