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NPI Code Detail

MEDICARE: MACK ERWIN PA-C

MEDICARE:   MACK  ERWIN  PA-C
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
1363A00000XPhysician Assistant101990NC

General Provider Information

NPI Number : 1386617090
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACK ERWIN PA-C
Provider Business Mailing Address
First Line : 1900 RANDOLPH RD
Second Line : SUITE 500
City : CHARLOTTE
State : NC
Zip : 28207-1106
Country : US
Telephone Number : 704-384-9113
Fax Number : 704-316-0508
Provider Business Practice Location Address
First Line : 8401 UNIVERSITY EXECUTIVE PARK DRIVE
Second Line : SUITE 125
City : CHARLOTTE
State : NC
Zip : 28262
Country : US
Telephone Number : 704-384-0570
Fax Number : 704-384-0571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2006
Last Update Date : 10/28/2020

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