Provider Demographics
NPI:1023034311
Name:PIXLEY, ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:PIXLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:STE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-446-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31355207V00000X
NC14579207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68072OtherBLUE CROSS BLUE SHIELD
SCN31355Medicaid
NC1023034311Medicaid
NC8968072Medicaid
SC240933431OtherBLUE CROSS BLUE SHIELD
NC209616GMedicare PIN
SC240933431OtherBLUE CROSS BLUE SHIELD
NC209616JMedicare PIN
NC1023034311Medicaid
NC209616FMedicare PIN
NC8968072Medicaid
SCN31355Medicaid