Provider Demographics
NPI:1356352207
Name:MAIER, RUDOLPH J (MD)
Entity type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:J
Last Name:MAIER
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 1:201 W ASH ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3665
Mailing Address - Country:US
Mailing Address - Phone:919-734-2428
Mailing Address - Fax:919-580-0212
Practice Address - Street 1:201 W ASH ST
Practice Address - Street 2:SUITE1
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3665
Practice Address - Country:US
Practice Address - Phone:919-734-2428
Practice Address - Fax:919-580-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC287752084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-53730Medicaid
NC208558CMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
NC89-53730Medicaid