Provider Demographics
NPI:1053399154
Name:RODRIGUEZ, DIANA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1027
Mailing Address - Country:US
Mailing Address - Phone:781-801-6149
Mailing Address - Fax:617-223-3038
Practice Address - Street 1:427 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1027
Practice Address - Country:US
Practice Address - Phone:781-801-6149
Practice Address - Fax:617-223-3038
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ECFMGOther344-909-7
PRMD LICENSEOther8452
PRMD LICENSEOther8452