Provider Demographics
NPI:1063408714
Name:RAAB, MARY J (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:RAAB
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Gender:F
Credentials:MD
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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:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:LEO JENKINS CANCER SERVICES
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-1888
Practice Address - Fax:252-744-7005
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-12-06
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Provider Licenses
StateLicense IDTaxonomies
NC22268207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC830002854OtherRAILROAD MEDICARE
NC69752OtherBCBS NC
NC8969752Medicaid
NCC86088Medicare UPIN
NC8969752Medicaid
NC209769KMedicare PIN