Provider Demographics
NPI:1528092947
Name:PRITCHARD, DOUGLAS D (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:PRITCHARD
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 63214
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3214
Mailing Address - Country:US
Mailing Address - Phone:704-818-0480
Mailing Address - Fax:704-818-0490
Practice Address - Street 1:610 SIGNAL HILL DRIVE EXT
Practice Address - Street 2:SUITE 100
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4337
Practice Address - Country:US
Practice Address - Phone:704-818-0480
Practice Address - Fax:704-818-0490
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18045207LP2900X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC74667OtherMEDCOST
NC132YCOtherBLUECROSSBLUESHIELD
NC2059778OtherAETNA
NC89132YCMedicaid
DG1403OtherRR MEDICARE
NC2059778OtherAETNA
NC209727AMedicare PIN
NC2578565Medicare PIN