Basic Information
| Provider Information | |||||||||
| NPI: | 1477539823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODES | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 ELLICOTT ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168931010 | ||||||||
| FaxNumber: | 7162352636 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 ELLICOTT ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168931010 | ||||||||
| FaxNumber: | 7162352636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 207147 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00010199503 | 01 | NY | UNIVERA | OTHER | 403066 | 01 | NY | WELLCARE | OTHER | 01670020 | 05 | NY | MEDICAID | 145837BJ | 01 | NY | PREFERRED CARE | OTHER | 040426035668 | 01 | NY | FIDELIS | OTHER | 0408448 | 01 | NY | IHA | OTHER | 000524430006 | 01 | NY | BC/BS | OTHER |