Provider Demographics
NPI:1871531269
Name:RODRIGUES, ALLAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-787-5115
Mailing Address - Fax:203-787-9736
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-787-5115
Practice Address - Fax:203-787-9736
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033716207R00000X, 207RC0200X, 207RP1001X
CT33716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1337163Medicaid
D400001810Medicare PIN
CT290000249Medicare ID - Type Unspecified
CTF20392Medicare UPIN