Provider Demographics
NPI:1427210251
Name:RODRIGUEZ, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:RODRIGUEZ
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 1:6 BLACKSTONE VALLEY PL STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1112
Mailing Address - Country:US
Mailing Address - Phone:401-762-3838
Mailing Address - Fax:401-762-8252
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1112
Practice Address - Country:US
Practice Address - Phone:401-762-3838
Practice Address - Fax:401-762-8252
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA269115207RC0000X, 207RC0001X
RIMD14964207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400359605Medicare UPIN