Provider Demographics
NPI:1326189663
Name:SCHRODER, DEREK QUENTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:QUENTIN
Last Name:SCHRODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DERECK
Other - Middle Name:
Other - Last Name:SCHRODER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7414
Practice Address - Country:US
Practice Address - Phone:919-859-5955
Practice Address - Fax:919-859-5659
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134NNOtherBCBS
8505117OtherCIGNA
NC89134NNMedicaid
C6382OtherMEDCOST
P00013681OtherRAILROAD MEDICARE
1427880OtherUNITED HEALTHCARE
NC134NNOtherBCBS
P00013681OtherRAILROAD MEDICARE