Provider Demographics
NPI:1053577601
Name:RODRIGUEZ, LIANA (DO)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 CENTRE TPKE
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9191
Mailing Address - Country:US
Mailing Address - Phone:570-366-2613
Mailing Address - Fax:570-366-2618
Practice Address - Street 1:1120 CENTRE TPKE
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-9191
Practice Address - Country:US
Practice Address - Phone:570-366-2613
Practice Address - Fax:570-366-2618
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12353207R00000X
MS23342207R00000X
PAOS021774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05351053Medicaid
MS05351053Medicaid