Provider Demographics
NPI:1730215716
Name:RODDA, MARY EVELYN (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:EVELYN
Last Name:RODDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6001
Mailing Address - Country:US
Mailing Address - Phone:845-729-0221
Mailing Address - Fax:845-225-9679
Practice Address - Street 1:441 ROUTE 52
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-6001
Practice Address - Country:US
Practice Address - Phone:845-729-0221
Practice Address - Fax:845-225-9679
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300031890Medicare PIN