Provider Demographics
NPI:1811948136
Name:RUNHEIM, ANDREAS D (MD)
Entity type:Individual
Prefix:
First Name:ANDREAS
Middle Name:D
Last Name:RUNHEIM
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 1:3333 BROOKVIEW HILLS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5661
Mailing Address - Country:US
Mailing Address - Phone:336-760-3007
Mailing Address - Fax:336-760-9334
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-760-3007
Practice Address - Fax:336-760-9334
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401571174400000X, 2084N0400X, 2084N0402X, 2084N0008X, 2084D0003X, 2084N0600X, 2084P0005X, 2084S0012X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904556Medicaid
NC200401571OtherLICENSE
NC5904556Medicaid
NCI53957Medicare UPIN
NC2052665Medicare PIN