Healthcare Provider Details

I. General information

NPI: 1750707154
Provider Name (Legal Business Name): PARTNERMD NORTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 PROVIDENCE RD SUITE 315
CHARLOTTE NC
28277-9716
US

IV. Provider business mailing address

8035 PROVIDENCE RD SUITE 315
CHARLOTTE NC
28277-9716
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-0800
  • Fax:
Mailing address:
  • Phone: 704-366-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500175
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL EMERY PARKS
Title or Position: REGIONAL MEDICAL DIRECTOR
Credential: MD
Phone: 703-288-3750