Provider Demographics
NPI:1508811530
Name:GEORGE L RAAD MD DBA
Entity Type:Organization
Organization Name:GEORGE L RAAD MD DBA
Other - Org Name:PARK ROAD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-523-2565
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0066
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:1700 ABBEY PL
Practice Address - Street 2:STE 200 PARK ROAD MEDICAL CLINIC
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3742
Practice Address - Country:US
Practice Address - Phone:704-523-2565
Practice Address - Fax:704-344-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81693Medicare UPIN
2320102Medicare PIN