Provider Demographics
NPI:1033160247
Name:MCRAE, CHAD E (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4488
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:7758 WALLACE ROAD,
Practice Address - Street 2:SUITE 6 CERTIFIED PEDIATRICS, IN ASSOC WITH NEMOURS,
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7217
Practice Address - Country:US
Practice Address - Phone:407-351-0082
Practice Address - Fax:407-374-1637
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87612208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267341000Medicaid
FL3240346OtherAETNA PROVIDER #
FL71408OtherBCBS PROVIDER #
FL5688069OtherCIGNA PROVIDER #