Provider Demographics
NPI:1083818082
Name:VANARSDELL, ROGER CLAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CLAY
Last Name:VANARSDELL
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 217
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NC
Mailing Address - Zip Code:28760-0217
Mailing Address - Country:US
Mailing Address - Phone:828-681-1839
Mailing Address - Fax:
Practice Address - Street 1:275 CANTERBURY WAY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792
Practice Address - Country:US
Practice Address - Phone:828-681-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911830Medicaid
NC2233716CMedicare PIN
NCA58843Medicare UPIN
NC2233716AMedicare ID - Type Unspecified