Provider Demographics
NPI:1457390528
Name:MON, RODRIGO (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:MON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 570
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2807
Mailing Address - Country:US
Mailing Address - Phone:404-785-6895
Mailing Address - Fax:404-785-6896
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6870
Practice Address - Country:US
Practice Address - Phone:803-434-4555
Practice Address - Fax:803-434-4599
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC936872086S0120X
GA89583208600000X
DCMD045742390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery