Provider Demographics
NPI:1962705897
Name:MCRAE, CHARLES D (BACHELORS DEGREE)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:MCRAE
Suffix:
Gender:M
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 W LONE MOUNTAIN RD APT 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5811
Mailing Address - Country:US
Mailing Address - Phone:702-205-1290
Mailing Address - Fax:
Practice Address - Street 1:6885 W LONE MOUNTAIN RD APT 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5811
Practice Address - Country:US
Practice Address - Phone:702-205-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner