Healthcare Provider Details

I. General information

NPI: 1598408627
Provider Name (Legal Business Name): RAKAN MAZEN AL-SULTANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALING WAY
MATTHEWS NC
28104-4969
US

IV. Provider business mailing address

6135 PARK SOUTH DR STE 510
CHARLOTTE NC
28210-0100
US

V. Phone/Fax

Practice location:
  • Phone: 800-821-1535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2025-01168
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: