Provider Demographics
NPI:1205883212
Name:KERECMAN, RICHARD ARDEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARDEN
Last Name:KERECMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:134 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8526
Mailing Address - Country:US
Mailing Address - Phone:704-799-7811
Mailing Address - Fax:704-799-7695
Practice Address - Street 1:407 GILEAD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6899
Practice Address - Country:US
Practice Address - Phone:704-875-2937
Practice Address - Fax:704-875-2939
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC16893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8948545Medicaid
NCNCF149AMedicare PIN
NC207826JMedicare PIN
NC207826MMedicare PIN
NCC84903Medicare UPIN
NC8948545Medicaid
NC207826HMedicare PIN