Provider Demographics
NPI:1962499541
Name:RAWL, RICHARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:RAWL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 RAILROAD ST W
Practice Address - Street 2:ECU PHYSICIANS FAMILY MEDICINE
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-9303
Practice Address - Country:US
Practice Address - Phone:252-744-0355
Practice Address - Fax:252-744-0350
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970570Medicaid
NC80104757OtherRAILROAD MEDICARE
NC70570OtherBCBS NC
NC80104757OtherRAILROAD MEDICARE
NC209826Medicare PIN