Healthcare Provider Details

I. General information

NPI: 1972577369
Provider Name (Legal Business Name): TRISHA R MCCREIGHT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RANDOLPH RD STE 900
CHARLOTTE NC
28207-1122
US

IV. Provider business mailing address

1900 RANDOLPH RD STE 900
CHARLOTTE NC
28207-1122
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-2424
  • Fax: 704-377-2687
Mailing address:
  • Phone: 704-377-2424
  • Fax: 704-377-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA9102440
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-00917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: