Provider Demographics
NPI:1255342937
Name:ESTONILO, RODRIGO (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:ESTONILO
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 1:100 EAGLESMERE CIR
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3144
Mailing Address - Country:US
Mailing Address - Phone:570-421-8772
Mailing Address - Fax:570-421-8775
Practice Address - Street 1:100 EAGLESMERE CIR
Practice Address - Street 2:SUITE 200A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3144
Practice Address - Country:US
Practice Address - Phone:570-421-8772
Practice Address - Fax:570-421-8775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042667L208VP0014X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161978Medicare PIN
PAF66652Medicare UPIN