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NPI Code Detail

MEDICARE: DR. RACHEL L. STURDIVANT M.D.

MEDICARE: DR. RACHEL L. STURDIVANT M.D.
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
1207RN0300XNephrology Physician22000SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225037765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RACHEL L. STURDIVANT M.D.
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number : 843-723-7404
Provider Business Practice Location Address
First Line : 171 ASHLEY AVENUE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-0100
Country : US
Telephone Number : 843-792-1414
Fax Number : 843-723-7404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 10/21/2020

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