Provider Demographics
NPI:1245277037
Name:RAKES, GARY PAIGE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PAIGE
Last Name:RAKES
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 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1415 ROLKIN CT
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3642
Practice Address - Country:US
Practice Address - Phone:434-951-2191
Practice Address - Fax:434-977-0200
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050099207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245277037Medicaid
VA00Y223A01OtherMEDICARE PTAN
VA5057181OtherAETNA USHC
VA1245277037Medicaid
VA00Y223A01OtherMEDICARE PTAN
F40818Medicare UPIN
VA00Y223A01OtherMEDICARE PTAN