Provider Demographics
NPI:1407830581
Name:RAINES, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RAINES
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC296482080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6020020Medicaid
40402OtherMEDCOST
2684OtherPARTNERS
4548531OtherAETNA
NC7969949Medicaid
WV2000336000Medicaid
69949OtherBCBS
60067966OtherRR MEDICARE
SCQ29648Medicaid
NC1407830581Medicaid
NCNCI548AMedicare PIN
NC7969949Medicaid
VA6020020Medicaid