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General NPI Number Information
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NPI Number | 1487739579
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Entity Type | Individual
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Provider Name | RICHARD M PAVELOCK MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 2632 FINES CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-4441
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Country | US
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Telephone | 704-838-0516
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Fax | 704-838-0565
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Provider Business Mailing Address
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Address Line | 2632 FINES CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-4441
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Country | US
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Telephone | 704-838-0516
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Fax | 704-838-0565
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39460
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number | 39460
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 39460
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39460
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License Number State | NC
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