Provider Demographics
NPI:1790744712
Name:PACHOLKE, HEATHER DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWN
Last Name:PACHOLKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3253
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4000
Practice Address - Fax:704-983-8250
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005002302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2040419BOtherMEDICARE PTAN
6365761OtherCIGNA
NC2040419COtherMEDICARE PTAN
NC5901549Medicaid
806973OtherPARTNERS
NCP00712368OtherMEDICARE - RAILROAD
2544164OtherUNITED HEALTHCARE
E3975OtherMEDCOST
NC13933OtherBLUE CROSS
NC2040419AOtherMEDICARE PTAN
NC2040419DOtherMEDICARE PTAN
NC2040419BOtherMEDICARE PTAN
NC2040419DOtherMEDICARE PTAN