DR. CORNELIO RODERICK RUPERTO (NPI# 1316065204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316065204 |
| Entity Type | Individual |
| Full Name | DR. CORNELIO RODERICK RUPERTO |
| Credential | MD |
| Practice Address |
6620 Shallowford Rd Suite 200 Lewisville NC 27023-9504 |
| Mailing Address |
350 Pilot Ridge Dr Lewisville NC 27023-8119 |
| Practice Telephone | 3369450345 |
| Practice Fax Number | 3369450342 |
| Mailing Telephone | 3369450345 |
| Mailing Fax Number | 3369450342 |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
2006-01732 | NC | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
2006-01732 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5900260 | 05 |
| Street Address |
6620 SHALLOWFORD RD SUITE 200 |
| City | LEWISVILLE |
| State | NC |
| Zip Code | 27023-9504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679665590 | Jennifer B Locklear | Counselor | 6620 Shallowford Rd, Suite 200, Lewisville, NC 27023-9504 | 2006-09-28 |
| 1811394612 | Novant Medical Group, Inc | Psychiatry & Neurology | 6620 Shallowford Rd, Suite 200, Lewisville, NC 27023-9504 | 2014-11-24 |
| 1780013037 | Lewisville Family Counseling, Pllc | Counselor | 6620 Shallowford Rd, Suite 200, Lewisville, NC 27023-9504 | 2013-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578106845 | Mary Margaret Johnson | Social Worker | 6614 Shallowford Rd. Suite 250, Lewisville, NC 27023 | 2019-10-19 |
| 1306127527 | Gohar Karami | Clinical Nurse Specialist | 200 Shallowford Reserve Dr #303, Lewisville, NC 27023 | 2011-09-01 |
| 1013107259 | Lewisville Optical Inc | Durable Medical Equipment & Medical Supplies | 6758 Shallowford Road, Lewisville, NC 27023 | 2007-07-25 |
| 1013112960 | Patrick Paul Welch | Counselor | 5041 Styers Ferry Rd, Lewisville, NC 27023 | 2007-06-20 |
| 1881736551 | Kathleen Diane Morin | Speech-Language Pathologist | 8800 Buckey Court, Lewisville, NC 27023 | 2007-02-12 |
| 1396836755 | Connie Lynn Marie Bigwood | Physical Therapist | 765 Manarda Circle, Lewisville, NC 27023 | 2006-09-28 |
| 1831272087 | Christopher Culley | Physician Assistant | 4622 Country Club Road, Suite 180, Winston-salem, NC 27023-3770 | 2006-10-23 |
| 1710353107 | Vanessa Fitzgerald | Peer Specialist | 423 Brookway West Dr, Lewisville, NC 27023-7602 | 2015-08-19 |
| 1497103451 | Frank Barron | Counselor | 1035 Kensford Dr, Lewisville, NC 27023-7635 | 2016-06-01 |
| 1144324591 | Yuegang Chen | Physician Assistant | 1052 Feldspa Ln., Lewisville, NC 27023-7639 | 2006-09-07 |
| Find all providers in zip 27023 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003432121 | North Carolina Neuropsychiatry, P.a. | Psychiatry & Neurology | 2080 Energy Dr, Apex, NC 27502-8722 | 2020-06-24 |
| 1073067492 | Teresa Tracy | Psychiatry & Neurology | 817 Mill Rd, Goldsboro, NC 27534-8947 | 2016-08-15 |
| 1659781581 | Il-gyu Cho | Psychiatry & Neurology | 101 Manning Dr. Cb#7160, Unc Department of Psychiatry, Chapel Hill, NC 27599 | 2014-04-30 |
| 1457770299 | Allison Foroobar | Psychiatry & Neurology | 400 Meadowmont Village Cir Ste 421, Chapel Hill, NC 27517-7505 | 2014-04-09 |
| 1386089894 | Christina Melissa Cruz | Psychiatry & Neurology | Department of Psychiatry Clb, 101 Manning Drive, Chapel Hill, NC 27599 | 2013-05-10 |
| 1497098420 | Neuropsychiatric Care Center, Pllc | Psychiatry & Neurology | 445 Dolley Madison Rd Ste 210, Greensboro, NC 27410-5169 | 2013-03-27 |
| 1033484555 | Jean Gaillard Spaulding | Psychiatry & Neurology | 2400 Pratt St Ste 1500, Box 3644 First Floor, Durham, NC 27705-3976 | 2012-03-16 |
| 1821366402 | Yvette Figueroa | Psychiatry & Neurology | 3801 Lake Boone Trail, Suite 150, Raleigh, NC 27607 | 2011-12-09 |
| 1598063307 | Corine's Care Management, Inc. | Psychiatry & Neurology | 369 B C Hwy 13 South, Snow Hill, NC 28580-9515 | 2011-03-02 |
| 1861705956 | Haven Ministries, Inc. | Psychiatry & Neurology | 3725b Wrightsville Ave, Wilmington, NC 28403-4140 | 2010-07-19 |
| Find all providers with the same taxonomy | ||||
| City | LEWISVILLE |
| Zip Code | 27023 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.