Provider Demographics
NPI:1295255289
Name:WOLDEMARIAM, RAHEL HAILEMICHAEL (MD)
Entity type:Individual
Prefix:
First Name:RAHEL
Middle Name:HAILEMICHAEL
Last Name:WOLDEMARIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 CRESTHILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7992
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11300 CRESTHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7992
Practice Address - Country:US
Practice Address - Phone:980-302-3550
Practice Address - Fax:980-302-3551
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-43491207Q00000X
PR32831208D00000X
NC2003-02607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice