Provider Demographics
NPI:1912099920
Name:RODRIGUEZ, RICARDO LUIS (MD)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:LUIS
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 1:1300 BELLONA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5465
Mailing Address - Country:US
Mailing Address - Phone:410-494-8100
Mailing Address - Fax:410-494-0815
Practice Address - Street 1:1300 BELLONA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5465
Practice Address - Country:US
Practice Address - Phone:410-494-8100
Practice Address - Fax:410-494-0815
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41395208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C67377Medicare UPIN
6948RLMedicare ID - Type Unspecified