Healthcare Provider Details

I. General information

NPI: 1033160247
Provider Name (Legal Business Name): CHAD E. MCRAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7758 WALLACE ROAD, SUITE 6 CERTIFIED PEDIATRICS, IN ASSOC WITH NEMOURS,
ORLANDO FL
32819-7217
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-0082
  • Fax: 407-374-1637
Mailing address:
  • Phone: 302-651-4488
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87612
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME87612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: