Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R200049 | MD |
NPI | 1003476748 |
---|---|
Provider Name | Mr. Arddhy Bulanadi Rodriguez |
First Address | Bethesda, MD 20817-2847 |
Second Address | Abingdon, MD 21009-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 03/02/2021 |