Provider Demographics
NPI:1043207616
Name:MCCAULEY, ROGER LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:MCCAULEY
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 1:175 KIMEL PARK DR
Mailing Address - Street 2:STE 115
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6951
Mailing Address - Country:US
Mailing Address - Phone:336-768-6930
Mailing Address - Fax:336-768-6328
Practice Address - Street 1:175 KIMEL PARK DR
Practice Address - Street 2:STE 115
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-768-6930
Practice Address - Fax:336-768-6328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955760Medicaid
NC8955760Medicaid
NC208646Medicare ID - Type Unspecified