Provider Demographics
NPI:1285772798
Name:COURTEMANCHE, DAVID RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RICHARD
Last Name:COURTEMANCHE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 TRENWEST DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3211
Mailing Address - Country:US
Mailing Address - Phone:336-922-1102
Mailing Address - Fax:336-922-5012
Practice Address - Street 1:3734 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2240
Practice Address - Country:US
Practice Address - Phone:336-922-1102
Practice Address - Fax:336-922-5012
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC153YJOtherBCBS
NC8102968Medicaid
NC8102968Medicaid