Provider Demographics
NPI:1811964224
Name:RHODES, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 BARTOL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2214
Mailing Address - Country:US
Mailing Address - Phone:610-521-0470
Mailing Address - Fax:610-521-3259
Practice Address - Street 1:1 BARTOL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2214
Practice Address - Country:US
Practice Address - Phone:610-521-0470
Practice Address - Fax:610-521-3259
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025276E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA055085Medicare ID - Type Unspecified
PAC28547Medicare UPIN