MEDICARE: DR. RACHEL RADER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	POD001007	GA

General Provider Information

NPI Number	:	1073516175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL RADER DPM

Provider Business Mailing Address
First Line	:	199 HOWARD POND LOOP
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-2280
Country	:	US
Telephone Number	:	704-872-0617
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 HOWARD POND LOOP
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-2280
Country	:	US
Telephone Number	:	704-872-0617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/02/2008

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