Provider Demographics
NPI:1962694679
Name:RODRIGUEZ, MARCO A (MD)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:A
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:PO BOX 85007
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-5007
Mailing Address - Country:US
Mailing Address - Phone:225-313-4700
Mailing Address - Fax:225-313-3656
Practice Address - Street 1:3001 DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5854
Practice Address - Country:US
Practice Address - Phone:504-620-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026718207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC316777Medicaid
TXN0410OtherTX MEDICAL LICENSE
LAMD.026718OtherLA MEDICAL LICENSE
SCAA40128499Medicare PIN