Healthcare Provider Details

I. General information

NPI: 1295709624
Provider Name (Legal Business Name): JOHN PASCAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10516 PARK RD
CHARLOTTE NC
28210-8405
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-9960
  • Fax: 704-384-9965
Mailing address:
  • Phone: 704-384-9960
  • Fax: 704-384-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32822
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: