Provider Demographics
NPI:1689668261
Name:REDELSPERGER, RODNEY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:LANE
Last Name:REDELSPERGER
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 1:294 N HIGHWAY 16
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8011
Mailing Address - Country:US
Mailing Address - Phone:704-489-2400
Mailing Address - Fax:704-489-2900
Practice Address - Street 1:294 N HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8011
Practice Address - Country:US
Practice Address - Phone:704-489-2400
Practice Address - Fax:704-489-2900
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133E0OtherBCBS
NC89133E0Medicaid
NCP00070763OtherRAILROAD MEDICARE
2331928Medicare ID - Type Unspecified
NC2012689Medicare PIN
NCH81261Medicare UPIN