Healthcare Provider Details

I. General information

NPI: 1881895530
Provider Name (Legal Business Name): RICHARD DARRELL MCGLOTHLIN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

IV. Provider business mailing address

PO BOX 2367
GRANITE BAY CA
95746-2367
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-5000
  • Fax: 910-615-9600
Mailing address:
  • Phone: 916-622-3609
  • Fax: 916-780-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19185
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09050
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA19185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: