Provider Demographics
NPI:1225455249
Name:RODERER, STEPHEN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:RODERER
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 1:5775 N MEADOWS DR STE D
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7300
Mailing Address - Country:US
Mailing Address - Phone:614-224-4200
Mailing Address - Fax:614-224-4207
Practice Address - Street 1:5775 N MEADOWS DR STE D
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7300
Practice Address - Country:US
Practice Address - Phone:614-224-4200
Practice Address - Fax:614-224-4207
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.127897207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.127897OtherSTATE LICENSE NUMBER