Provider Demographics
NPI:1215902713
Name:ROY, SUDIP K (MD)
Entity type:Individual
Prefix:DR
First Name:SUDIP
Middle Name:K
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6773
Mailing Address - Country:US
Mailing Address - Phone:336-243-8615
Mailing Address - Fax:336-243-8624
Practice Address - Street 1:101 W MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6773
Practice Address - Country:US
Practice Address - Phone:336-243-8615
Practice Address - Fax:336-243-8624
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC801005OtherPARTNERS MEDICARE CHOICE
NC0102624OtherUHC
NC2943871OtherAETNA - HMO
NC891310JMedicaid
NY7044299OtherAETNA - NON HMO
NC0651247001OtherCIGNA
NC080190706OtherRAILROAD MEDICARE NUMBER
NC257146OtherMAMSI
NC1310JOtherBCBS NUMBER
NCB9190OtherMEDCOST NUMBER
NCB9190OtherMEDCOST NUMBER
NC891310JMedicaid