Provider Demographics
NPI:1073508149
Name:ISRAEL, RODGER D (MD)
Entity type:Individual
Prefix:DR
First Name:RODGER
Middle Name:D
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3100 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8036
Mailing Address - Country:US
Mailing Address - Phone:919-781-7500
Mailing Address - Fax:919-645-3054
Practice Address - Street 1:3237 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8036
Practice Address - Country:US
Practice Address - Phone:919-781-7500
Practice Address - Fax:919-645-3054
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31539207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945461Medicaid
NC8945461Medicaid
NCC87507Medicare UPIN