Provider Demographics
NPI:1932203544
Name:RODRIGUEZ SOTOMAYOR, MATILDE R (MD)
Entity Type:Individual
Prefix:
First Name:MATILDE
Middle Name:R
Last Name:RODRIGUEZ SOTOMAYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MATILDE
Other - Middle Name:RODRIGUEZ
Other - Last Name:SOTOMAYOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1220 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1458
Mailing Address - Country:US
Mailing Address - Phone:610-898-1200
Mailing Address - Fax:610-898-7600
Practice Address - Street 1:1220 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-1458
Practice Address - Country:US
Practice Address - Phone:610-898-1200
Practice Address - Fax:610-898-7600
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032776E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA190607Medicare ID - Type Unspecified