Provider Demographics
NPI:1225052673
Name:GONCALVES, ROD M (MD)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:M
Last Name:GONCALVES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:330 NC HWY 108
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139
Mailing Address - Country:US
Mailing Address - Phone:828-286-1743
Mailing Address - Fax:828-287-3731
Practice Address - Street 1:401 MULBERRY ST SW STE 202
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-6146
Practice Address - Fax:828-757-5944
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCNC2011-01543208600000X
TN35448208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33646Medicare UPIN
NCNC7449AMedicare UPIN