Basic Information
Provider Information
NPI: 1649320284
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RANKINS
FirstName: VICTORIA
MiddleName: ROGERS
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 14883
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274154883
CountryCode: US
TelephoneNumber: 3362746515
FaxNumber: 3362750812
Practice Location
Address1: 1210 NEW GARDEN RD
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274102721
CountryCode: US
TelephoneNumber: 3362946190
FaxNumber: 3362946278
Other Information
ProviderEnumerationDate: 01/12/2007
LastUpdateDate: 04/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X98-00125NCY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
891145L05OK MEDICAID
892618701NCCIGNAOTHER
926160201NCAETNAOTHER


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