Provider Demographics
NPI:1609857689
Name:COLVARD, DAVID FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FRED
Last Name:COLVARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5108
Mailing Address - Country:US
Mailing Address - Phone:919-782-1761
Mailing Address - Fax:919-782-1761
Practice Address - Street 1:1213 GRANADA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5108
Practice Address - Country:US
Practice Address - Phone:919-782-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC242352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23831OtherBCBSNC PROVIDER NUMBER
NCC81499Medicare UPIN
NC23831OtherBCBSNC PROVIDER NUMBER