Provider Demographics
NPI:1073593943
Name:SHEALY, RONALD BERNARD (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:BERNARD
Last Name:SHEALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:110 CHARLOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1522
Mailing Address - Country:US
Mailing Address - Phone:336-768-3361
Mailing Address - Fax:336-768-4131
Practice Address - Street 1:110 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1522
Practice Address - Country:US
Practice Address - Phone:336-768-3361
Practice Address - Fax:336-768-4131
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC24519207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30636OtherMEDCOST
VA6525253OtherVIRGINIA MEDICAID
NC75581OtherBLUE CROSS BLUE SHIELD
NC040011654OtherRAILROAD MEDICARE
NC7975581Medicaid
NC391OtherPARTNERS
NC1000673OtherUNITED HEALTHCARE
NC75581OtherBLUE CROSS BLUE SHIELD
NC7975581Medicaid