Provider Demographics
NPI:1881654663
Name:CARR, DAVID RUDDLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUDDLE
Last Name:CARR
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:336-765-5221
Mailing Address - Fax:704-765-0430
Practice Address - Street 1:2825 LYNDHURST AVE STE 101
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4146
Practice Address - Country:US
Practice Address - Phone:336-277-6300
Practice Address - Fax:336-277-6309
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34830208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921291Medicaid
NC34830OtherNC LICENSE
NC34830OtherNC LICENSE
NC2170705AMedicare PIN
NCBC2096914OtherDEA NUMBER
NC2170705Medicare ID - Type Unspecified