Healthcare Provider Details

I. General information

NPI: 1649702846
Provider Name (Legal Business Name): DAVID A PRAHL III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 CREEDMOOR RD STE 114
RALEIGH NC
27613-3697
US

IV. Provider business mailing address

6500 CREEDMOOR RD STE 114
RALEIGH NC
27613-3697
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-3590
  • Fax:
Mailing address:
  • Phone: 919-782-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1481
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: