Provider Demographics
NPI:1134123847
Name:ECHT, AUDREY F (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:F
Last Name:ECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 RAVEN RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6499
Mailing Address - Country:US
Mailing Address - Phone:919-870-6600
Mailing Address - Fax:919-870-1610
Practice Address - Street 1:10931 RAVEN RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-870-6600
Practice Address - Fax:919-870-1610
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000409207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127F7OtherMEDICAID
NC89127F7OtherMEDICAID
NC2281098AMedicare PIN
G27857Medicare UPIN