Individual
DR. CORNELIO RODERICK RUPERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6620 SHALLOWFORD RD, SUITE 200, LEWISVILLE, NC 27023-9504
(336) 945-0345
(336) 945-0342
Mailing address
350 PILOT RIDGE DR, LEWISVILLE, NC 27023-8119
(336) 945-0345
(336) 945-0342
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2006-01732
NC
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2006-01732
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900260
—
NC
Enumeration date
03/27/2007
Last updated
10/25/2020
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