Provider Demographics
NPI:1841361367
Name:MARADIAGA, GERARDO MARCIAL (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:MARCIAL
Last Name:MARADIAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:270 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4914
Mailing Address - Country:US
Mailing Address - Phone:252-537-0134
Mailing Address - Fax:252-537-6515
Practice Address - Street 1:270 SMITH CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-0134
Practice Address - Fax:252-537-6515
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC895389BMedicaid
VA028182Other028182
0455333OtherUNITED HEALTHCARE
1435956HALIOtherUNITED MINE WORKERS
6040047OtherVIRGINIA MEDICAID
020384900OtherDIVISION OF COAL MINERS
18619OtherCAPITOL BC PENN
75228OtherMEDCOST
110093479OtherRAILROAD MEDICARE PALMETT
NC5389BOtherBCBSNC
020384900OtherDIVISION OF COAL MINERS
6040047OtherVIRGINIA MEDICAID