Provider Demographics
NPI:1326141672
Name:REXRODE, NORMAN JR (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:REXRODE
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 1:3600 TATE AND CARROLL STREETS
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-883-8200
Mailing Address - Fax:276-889-0465
Practice Address - Street 1:3600 TATE AND CARROLL STREETS
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8200
Practice Address - Fax:276-889-0465
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031383207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326141672Medicaid
VAD85340Medicare UPIN
VAVAA104614Medicare PIN