Healthcare Provider Details

I. General information

NPI: 1104010156
Provider Name (Legal Business Name): CUPID FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W. ARBORS DR. SUITE 102
CHARLOTTE NC
28262-2559
US

IV. Provider business mailing address

2325 W. ARBORS DR. SUITE 102
CHARLOTTE NC
28262-2559
US

V. Phone/Fax

Practice location:
  • Phone: 704-971-4445
  • Fax: 704-971-4450
Mailing address:
  • Phone: 704-971-4445
  • Fax: 704-971-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200301427
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21652
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200301427
License Number StateNC

VIII. Authorized Official

Name: DR. MELISSA JO-ANN CUPID
Title or Position: CEO
Credential: MD
Phone: 704-971-4445