Provider Demographics
NPI:1649373069
Name:JUSTIN, RODNEY K (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:K
Last Name:JUSTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:620 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:WOODLEAF
Mailing Address - State:NC
Mailing Address - Zip Code:27054-9356
Mailing Address - Country:US
Mailing Address - Phone:704-278-4359
Mailing Address - Fax:704-278-4782
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-330-1700
Practice Address - Fax:704-330-1716
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-18
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Provider Licenses
StateLicense IDTaxonomies
NC191722083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C80727Medicare UPIN