Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D0063913 | MD |
NPI | 1043304348 |
---|---|
Provider Name | Dr. Michael Porter Rodrigues |
First Address | Bel Air, MD 21014 |
Second Address | Bel Air, MD 21014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 25/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
409514600 | (05) | MD |
64833001 | CAREFIRST (01) | MD |
E5130012 | CAREFIRST BLUE CHOICE (01) | DC |
I51426 | (02) |