Provider Demographics
NPI:1023171121
Name:CRONIN, RACHELLE MARIA (PAC)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:MARIA
Last Name:CRONIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:RACHELLE
Other - Middle Name:MARIA
Other - Last Name:COLOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:13557 STEELECROFT PKWY
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0057
Mailing Address - Country:US
Mailing Address - Phone:704-587-3200
Mailing Address - Fax:704-587-0044
Practice Address - Street 1:13557 STEELECROFT PKWY
Practice Address - Street 2:SUITE 2500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-0057
Practice Address - Country:US
Practice Address - Phone:704-587-3200
Practice Address - Fax:704-587-0044
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2768315Medicare PIN
NCQ77653Medicare UPIN