Provider Demographics
NPI:1336109065
Name:RAPPAPORT, RICHARD (PA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 HWY 70 W
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4503
Mailing Address - Country:US
Mailing Address - Phone:252-808-3696
Mailing Address - Fax:252-808-2022
Practice Address - Street 1:5059 HWY 70 W
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4503
Practice Address - Country:US
Practice Address - Phone:252-808-3696
Practice Address - Fax:252-808-2022
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2760478Medicare ID - Type Unspecified
NCQ11501Medicare UPIN