Provider Demographics
NPI:1245279447
Name:RODRIGUEZ, GLORIA J (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 FAIRFAX DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1665
Mailing Address - Country:US
Mailing Address - Phone:240-384-3442
Mailing Address - Fax:
Practice Address - Street 1:4250 FAIRFAX DR STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1665
Practice Address - Country:US
Practice Address - Phone:240-384-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012876232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02573077Medicaid
NYL10166Medicare UPIN