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NPI Code Detail

MEDICARE: DR. DAVID E MERMELSTEIN PH.D.

MEDICARE: DR. DAVID E MERMELSTEIN PH.D.
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
1103TC0700XClinical Psychologist4011NC

General Provider Information

NPI Number : 1790029791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID E MERMELSTEIN PH.D.
Provider Business Mailing Address
First Line : 6201 FAIRVIEW RD STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3297
Country : US
Telephone Number : 704-372-0670
Fax Number :
Provider Business Practice Location Address
First Line : 6201 FAIRVIEW ROAD, STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3297
Country : US
Telephone Number : 704-372-0670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 11/15/2012

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