Provider Demographics
NPI:1922083146
Name:ROCKINGHAM UROLOGY ASSOC
Entity Type:Organization
Organization Name:ROCKINGHAM UROLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:336-634-0790
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:336-634-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72530208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2381OtherPARTNERS MEDICARE
NC890121CMedicaid
NC0121COtherBLUE CROSS BLUE SHIELD
NC5778940001Medicare NSC
NC2381OtherPARTNERS MEDICARE