Healthcare Provider Details

I. General information

NPI: 1356352207
Provider Name (Legal Business Name): RUDOLPH J MAIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W ASH ST SUITE1
GOLDSBORO NC
27530-3665
US

IV. Provider business mailing address

201 W ASH ST SUITE1
GOLDSBORO NC
27530-3665
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-2428
  • Fax: 919-580-0212
Mailing address:
  • Phone: 919-734-2428
  • Fax: 919-580-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number28775
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: