Provider Demographics
NPI:1386737534
Name:STANLEY, RODNEY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JAY
Last Name:STANLEY
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 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:124 WELTON WAY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9163
Practice Address - Country:US
Practice Address - Phone:704-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01142207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904690Medicaid
NC89015XTOtherMEDICAID GROUP ID
NC4519120001OtherPALMETTO GBE DMERC GROUP ID
NCDE4365OtherRAILROAD MEDICARE GROUP ID
NC015XTOtherBCBS GROUP ID
LAMD025310OtherMD LICENSE
NCP00401272OtherRAILROAD MEDICARE INDIVIDUAL ID
NC1428YOtherBCBS
TXM2127OtherMD LICENSE
NC2006-01142OtherNC STATE LIC
NC1428YOtherBCBS
NCP00401272OtherRAILROAD MEDICARE INDIVIDUAL ID
NCNCK330AMedicare PIN