Provider Demographics
NPI:1811439169
Name:RODRIGUES, ANTHONY MARK (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARK
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CORNWALL ST NW STE D
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2701
Mailing Address - Country:US
Mailing Address - Phone:703-777-3262
Mailing Address - Fax:
Practice Address - Street 1:2509 PLEASANT RUN DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8720
Practice Address - Country:US
Practice Address - Phone:540-689-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005524363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical