Provider Demographics
NPI:1225204449
Name:MILTON R RODRIGUES
Entity type:Organization
Organization Name:MILTON R RODRIGUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-925-8099
Mailing Address - Street 1:256 SOUTH TEN STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5750
Mailing Address - Country:US
Mailing Address - Phone:215-925-8099
Mailing Address - Fax:215-592-0295
Practice Address - Street 1:256 SOUTH TEN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5750
Practice Address - Country:US
Practice Address - Phone:215-925-8099
Practice Address - Fax:215-592-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4630270001Medicare NSC