Provider Demographics
NPI:1639361108
Name:ROCAMORA, LEE RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:RUSSELL
Last Name:ROCAMORA
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:PO BOX 60063
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0063
Mailing Address - Country:US
Mailing Address - Phone:704-302-8800
Mailing Address - Fax:704-632-4001
Practice Address - Street 1:200 S. COLLEGE ST.
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:704-302-8800
Practice Address - Fax:704-632-4001
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7972773Medicaid
SCNC1489Medicaid
NCNC2720HMedicare PIN
NCNC2720CMedicare PIN
SCNC1489Medicaid
NCNC2720DMedicare PIN
NCNC2720EMedicare PIN
NCNC2720FMedicare PIN
NCNC2720GMedicare PIN
NCNC2720BMedicare PIN