Healthcare Provider Details

I. General information

NPI: 1760475537
Provider Name (Legal Business Name): CHARLOTTE PAIN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10504 PARK RD SUITE 100
CHARLOTTE NC
28210-8405
US

IV. Provider business mailing address

10504 PARK RD SUITE 100
CHARLOTTE NC
28210-8405
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-7727
  • Fax: 704-367-9174
Mailing address:
  • Phone: 704-364-7727
  • Fax: 704-367-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACY MARSHALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-364-7727