Provider Demographics
NPI:1093762395
Name:STALHEIM, RODNEY M (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:M
Last Name:STALHEIM
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 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-5939
Practice Address - Street 1:322 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5703
Practice Address - Country:US
Practice Address - Phone:828-757-6400
Practice Address - Fax:828-757-6424
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979136Medicaid
NC79136OtherBCBS
NC2168357AMedicare ID - Type Unspecified
NC8979136Medicaid