Provider Demographics
NPI:1629155007
Name:ROCKINGHAM UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ROCKINGHAM UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETHU
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-342-4791
Mailing Address - Street 1:1818 RICHARDSON DR STE F
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5450
Mailing Address - Country:US
Mailing Address - Phone:336-342-4791
Mailing Address - Fax:
Practice Address - Street 1:1818 RICHARDSON DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5450
Practice Address - Country:US
Practice Address - Phone:336-342-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2381OtherPARTNERS
NC0121COtherBLUE CROSS
NC890121CMedicaid
NC1210Medicare PIN
NC890121CMedicaid