Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2001-00620 | NC |
NPI | 1083696892 |
---|---|
Provider Name | Dr. Ronald Vandernoord |
First Address | Charlotte, NC 28209-3239 |
Second Address | Matthews, NC 28105-5082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 20/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89129TN | (05) | NC |
G74507 | (02) | NC |
N00620 | (05) | SC |