Provider Demographics
NPI:1174566947
Name:ZEA, RODOLFO LUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:LUIS
Last Name:ZEA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RUDY
Other - Middle Name:LUIS
Other - Last Name:ZEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2101 LAMAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1821
Mailing Address - Country:US
Mailing Address - Phone:410-893-5669
Mailing Address - Fax:
Practice Address - Street 1:2101 LAMAR CT
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1821
Practice Address - Country:US
Practice Address - Phone:410-893-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6100130OtherEVERCARE
MD60484701OtherBLUE CROSS BLUE SHIELD
DCG3960012OtherBC/BS NATIONAL CAPITAL
MD019048T24Medicare PIN
MD6100130OtherEVERCARE