Provider Demographics
NPI:1669018529
Name:RODRIGUEZ, DONNA VICTORIA (PA)
Entity type:Individual
Prefix:MR
First Name:DONNA
Middle Name:VICTORIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:121 MEDICAL CENTER DR STE 3400
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2675
Mailing Address - Country:US
Mailing Address - Phone:207-406-7300
Mailing Address - Fax:207-835-4736
Practice Address - Street 1:121 MEDICAL CENTER DR STE 3400
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2675
Practice Address - Country:US
Practice Address - Phone:207-406-7300
Practice Address - Fax:207-835-4736
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA2684363AS0400X, 363A00000X
FL9112618363AM0700X
TXPA14583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant