Healthcare Provider Details

I. General information

NPI: 1528092947
Provider Name (Legal Business Name): DOUGLAS D PRITCHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SIGNAL HILL DRIVE EXT SUITE 100
STATESVILLE NC
28625-4337
US

IV. Provider business mailing address

PO BOX 63214
CHARLOTTE NC
28263-3214
US

V. Phone/Fax

Practice location:
  • Phone: 704-818-0480
  • Fax: 704-818-0490
Mailing address:
  • Phone: 704-818-0480
  • Fax: 704-818-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number18045
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number18045
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: