MEDICARE: MR. RONALD BERNARD SHEALY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	24519	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	040011654	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30636	OTHER	NC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	75581	OTHER	NC	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	391	OTHER	NC	PARTNERS
7	1000673	OTHER	NC	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1073593943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD BERNARD SHEALY MD

Provider Business Mailing Address
First Line	:	110 CHARLOIS BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1522
Country	:	US
Telephone Number	:	336-768-3361
Fax Number	:	336-768-4131

Provider Business Practice Location Address
First Line	:	110 CHARLOIS BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1522
Country	:	US
Telephone Number	:	336-768-3361
Fax Number	:	336-768-4131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/15/2012

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