Provider Demographics
NPI:1740226760
Name:MCRAE, ALEXIS NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:NICOLE
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 E INDEPENDENCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4628
Practice Address - Country:US
Practice Address - Phone:704-815-5624
Practice Address - Fax:704-815-5621
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224798207P00000X
NC200101096207P00000X
SC87706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129RRMedicaid
NC2290650KMedicare PIN
NC89129RRMedicaid
NC2290650FMedicare PIN