Provider Demographics
NPI:1215047543
Name:SCALLION, RICHARD RALPH (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RALPH
Last Name:SCALLION
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:257 HOSPITAL DRIVE SUITE 200
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8411
Practice Address - Country:US
Practice Address - Phone:910-721-4000
Practice Address - Fax:910-721-4001
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29512208600000X
NC200700127208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905853Medicaid
NC5905853Medicaid
NC3812561Medicare ID - Type Unspecified
NC2063032Medicare PIN