Provider Demographics
NPI:1003026550
Name:ROEDIGER, LARRY NMI (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:NMI
Last Name:ROEDIGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2609 N DUKE ST
Mailing Address - Street 2:STE 303B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3019
Mailing Address - Country:US
Mailing Address - Phone:336-998-3707
Mailing Address - Fax:
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4382
Practice Address - Fax:704-984-4631
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant