Provider Demographics
NPI:1962199943
Name:RODRICKS, DANIEL GREGORY (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GREGORY
Last Name:RODRICKS
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:DEPARTMENT OF MEDICAL EDUCATION/ANNEX: SECOND FLOOR
Mailing Address - Street 2:500 J CLYDE MORRIS BLVD
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1929
Mailing Address - Country:US
Mailing Address - Phone:757-594-3945
Mailing Address - Fax:757-594-3184
Practice Address - Street 1:DEPARTMENT OF MEDICAL EDUCATION/ANNEX: SECOND FLOOR
Practice Address - Street 2:500 J CLYDE MORRIS BLVD
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-3945
Practice Address - Fax:757-594-3184
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program