Provider Demographics
NPI:1083674428
Name:RHENEY, THEODORE BRANEH JR (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:BRANEH
Last Name:RHENEY
Suffix:JR
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 1:1065 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-204-3577
Mailing Address - Fax:828-253-6960
Practice Address - Street 1:1065 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-204-3577
Practice Address - Fax:828-253-6960
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500198207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7971410Medicaid
G01358Medicare UPIN
NC7971410Medicaid