Provider Demographics
NPI:1265646582
Name:DAVID, RACHAL ALICE (MD)
Entity Type:Individual
Prefix:
First Name:RACHAL
Middle Name:ALICE
Last Name:DAVID
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 1:241 SOUTHAVEN COURT
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083
Mailing Address - Country:US
Mailing Address - Phone:504-296-6842
Mailing Address - Fax:
Practice Address - Street 1:241 SOUTHAVEN COURT
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083
Practice Address - Country:US
Practice Address - Phone:504-296-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01479207Q00000X, 208M00000X
NC121952207Q00000X
LA320994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14675OtherBCBS
NC14675OtherBCBS
NC2073363AMedicare PIN
NC2073363BMedicare PIN
NC2073363Medicare PIN