Provider Demographics
NPI:1316967037
Name:RODRIGUEZ, ALBERTO J (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2508
Mailing Address - Country:US
Mailing Address - Phone:860-296-4022
Mailing Address - Fax:860-772-0095
Practice Address - Street 1:345 N MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2508
Practice Address - Country:US
Practice Address - Phone:860-296-4022
Practice Address - Fax:860-236-3002
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT26403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001264035Medicaid
CT001264035Medicaid