Provider Demographics
NPI:1316964901
Name:FLETCHER, RICHARD VAN
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:STE. 207C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:
Practice Address - Street 1:721 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3928
Practice Address - Country:US
Practice Address - Phone:336-905-6450
Practice Address - Fax:336-905-6451
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22396207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160029232OtherRAILROAD MEDICARE
NC8932666Medicaid
NC206329CMedicare PIN
NC160029232OtherRAILROAD MEDICARE
NC206329DMedicare PIN