Healthcare Provider Details

I. General information

NPI: 1881653293
Provider Name (Legal Business Name): PETER JAMES MENKHAUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 EAST BLVD
CHARLOTTE NC
28203-5203
US

IV. Provider business mailing address

927 EAST BLVD
CHARLOTTE NC
28203-5203
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-5772
  • Fax: 704-377-3389
Mailing address:
  • Phone: 704-377-5772
  • Fax: 704-377-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9900100
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16351
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16351
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: