Provider Demographics
NPI:1043304348
Name:RODRIGUES, MICHAEL PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PORTER
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-879-0227
Practice Address - Street 1:520 UPPER CHESAPEAKE DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-879-9100
Practice Address - Fax:410-879-0227
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0063913207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409514600Medicaid
MD64833001OtherCAREFIRST
DCE5130012OtherCAREFIRST BLUE CHOICE
MD519LN708Medicare ID - Type Unspecified
MD409514600Medicaid