Provider Demographics
NPI:1821005356
Name:ROHDE, KAREN (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ROHDE
Suffix:
Gender:F
Credentials:PA
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 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:119 MARKET PLACE AVE STE D
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9157
Practice Address - Country:US
Practice Address - Phone:704-631-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821005356Medicaid
NCNCG959DMedicare PIN
NC1821005356Medicaid
NCNCG959EMedicare PIN
NCNCG959BMedicare PIN
NCS70599Medicare UPIN
NC2750046Medicare ID - Type Unspecified
NCNCG959CMedicare PIN