Individual
DR. RAYMOND THERTULIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 QUEENS RD STE 610, CHARLOTTE, NC 28204-3580
(980) 302-6600
(980) 302-6605
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2007-00361
NC
207RH0000X
Hematology (Internal Medicine) Physician
Primary
2007-00361
NC
207RH0003X
Hematology & Oncology Physician
2007-00361
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143705001
—
AR
01
—
4510132
CIGNA
NC
05
—
5906570
—
NC
01
—
7964243
AETNA
NC
01
—
P01028293
RAILROAD MEDICARE
NC
Enumeration date
04/17/2007
Last updated
07/11/2024
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