MEDICARE: DR. RODNEY LANE REDELSPERGER M.D.

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	207R00000X	Internal Medicine Physician	200200785	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00070763	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133E0	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689668261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY LANE REDELSPERGER M.D.

Provider Business Mailing Address
First Line	:	294 N HIGHWAY 16
Second Line	:	SUITE A
City	:	DENVER
State	:	NC
Zip	:	28037-8011
Country	:	US
Telephone Number	:	704-489-2400
Fax Number	:	704-489-2900

Provider Business Practice Location Address
First Line	:	294 N HIGHWAY 16
Second Line	:	SUITE A
City	:	DENVER
State	:	NC
Zip	:	28037-8011
Country	:	US
Telephone Number	:	704-489-2400
Fax Number	:	704-489-2900

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/17/2008

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