Provider Demographics
NPI:1922070184
Name:RACKOFF, GEOFFREY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:DAVID
Last Name:RACKOFF
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:STE 300
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-403-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1561819OtherCIGNA HEALTHCARE
NC8910501Medicaid
NC297407OtherMAMSI
NC566000156OtherGROUP TAX ID
NC5337523OtherAETNA
NC10501OtherBCBS
NC232009OtherMEDICARE
NC73279OtherMEDCOST
NC26901OtherPARTNERS MEDICARE CHOICE
NCP00268166OtherRAILROAD MEDICARE
NC8910501Medicaid
NC26901OtherPARTNERS MEDICARE CHOICE
NC297407OtherMAMSI