Provider Demographics
NPI:1659344398
Name:RACHIMA, RICHARD RON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RON
Last Name:RACHIMA
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9960
Mailing Address - Fax:704-384-9965
Practice Address - Street 1:10514 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8405
Practice Address - Country:US
Practice Address - Phone:704-384-9960
Practice Address - Fax:704-384-9965
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912966Medicaid
SCN00933Medicaid
NC8912966Medicaid
NCH49959Medicare UPIN