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General NPI Number Information
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NPI Number | 1124120290
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Entity Type | Individual
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Provider Name | DAVID ANTHONY RODEBERG MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 517 MOYE BLVD
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City | GREENVILLE
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State | NC
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Zip | 27834-2849
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Country | US
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Telephone | 252-744-2832
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Fax | 252-744-3457
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Provider Business Mailing Address
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Address Line | PO BOX 751069
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City | CHARLOTTE
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State | NC
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Zip | 28275-1069
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | MD429509
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | TP683
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 2010-00640
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License Number State | NC
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