Individual
TIMOTHY STARLING ROUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 BLYTHE BLVD, SUITE 300 - CARDIAC SURGERY:, CHARLOTTE, NC 28203-5863
(704) 373-0212
(704) 372-1249
Mailing address
PO BOX 601067, CHARLOTTE, NC 28260-1067
(704) 373-0212
(704) 372-1248
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
200100085
NC
208600000X
Surgery Physician
35-069667
OH
2086S0129X
Vascular Surgery Physician
Primary
200100085
NC
2086S0129X
Vascular Surgery Physician
35-069667
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128A4
BCBS
NC
05
—
1720091499
—
NC
05
—
89128A4
—
NC
05
—
N0076B
—
SC
01
—
P00200674
RAILROAD MEDICARE
—
Enumeration date
08/14/2006
Last updated
12/05/2016
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