Provider Demographics
NPI:1699867218
Name:RIVELL, JAMES PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:RIVELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:570 MOOSE RD N
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-9539
Mailing Address - Country:US
Mailing Address - Phone:704-436-8242
Mailing Address - Fax:
Practice Address - Street 1:319 PENNY LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-403-7575
Practice Address - Fax:704-403-7570
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971730Medicaid
NCF73637Medicare UPIN
NC8971730Medicaid
NCNCE855AMedicare PIN