Provider Demographics
NPI:1366583213
Name:RAUSTOL, OLE A (MD)
Entity type:Individual
Prefix:
First Name:OLE
Middle Name:A
Last Name:RAUSTOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-250-2833
Mailing Address - Fax:828-651-6559
Practice Address - Street 1:11 VANDERBILT PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-213-1740
Practice Address - Fax:828-213-1742
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-02101208000000X
NC201002101207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906059Medicaid
VA1366583213Medicaid
VA1366583213Medicaid