Provider Demographics
NPI:1679513998
Name:RAAD, GEORGE LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LOUIS
Last Name:RAAD
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 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 201 PARK ROAD MEDICAL CLINIC
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:704-523-2565
Practice Address - Fax:704-344-1241
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81693Medicare UPIN
203170DMedicare ID - Type Unspecified