Provider Demographics
NPI:1316134505
Name:RODRIGUES, MIGUEL C (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:C
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HAWTHORNE PL
Mailing Address - Street 2:APT. #8-N
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2344
Mailing Address - Country:US
Mailing Address - Phone:617-997-3357
Mailing Address - Fax:
Practice Address - Street 1:9 HAWTHORNE PL
Practice Address - Street 2:APT. #8-N
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2344
Practice Address - Country:US
Practice Address - Phone:617-997-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA792102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology