Provider Demographics
NPI:1174534150
Name:RODIS, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:RODIS
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 1:30 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3628
Practice Address - Country:US
Practice Address - Phone:203-276-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026709207VG0400X, 207VM0101X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1217165OtherUNITED HEALTHCARE
CT2565150OtherAETNA
CTTINOtherPIONEER
CT2V0998OtherHEALTH NET
CTTINOtherMULTIPLAN
CTTINOtherPOMCO
CTTINOtherNEHCA
CT026709OtherCONNECTICARE
CTTINOtherFOCUS-CONENTRA
CT010026709CT04OtherANTHEM BC/BS
CTTINOtherFIRST HEALTH
CT462D71OtherEMPIRE BC/BS
CTHAS157OtherOXFORD HEALTH PLANS
CTTINOtherCIGNA
CTTINOtherGREAT WEST
CTTINOtherCONSUMER HEALTH NETWORK
CTTINOtherPRIVATE HEALTHCARE SYSTEM
CTTINOtherPIONEER