Provider Demographics
NPI:1669436994
Name:RODENBERG, DENNY
Entity type:Individual
Prefix:
First Name:DENNY
Middle Name:
Last Name:RODENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2150
Mailing Address - Fax:336-802-2151
Practice Address - Street 1:1041 KIRKPATRICK RD STE 150
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8068
Practice Address - Country:US
Practice Address - Phone:336-663-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2249106AOtherMEDICARE PTAN
NC6902961Medicaid
NC6902961Medicaid
NCF-90631Medicare UPIN