Individual
CARL ROBERT NORDSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
739 E OAKWOOD AVE, ALBEMARLE, NC 28001-4249
(704) 550-5860
Mailing address
739 E OAKWOOD AVE, ALBEMARLE, NC 28001-4249
(704) 550-5860
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0022424
NC
207Q00000X
Family Medicine Physician
Primary
22424
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080100464
RAIL ROAD MEDICARE
—
01
—
63026
BC/BS
NC
05
—
8963026
—
NC
Enumeration date
11/07/2005
Last updated
03/05/2015
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