Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2010-00640 | NC |
N | 2086S0120X | Pediatric Surgery | MD429509 | PA |
NPI | 1124120290 |
---|---|
Provider Name | David Anthony Rodeberg |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-2849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158YP | BCBSNC (01) | NC |
5914874 | (05) | NC |