Healthcare Provider Details

I. General information

NPI: 1770035479
Provider Name (Legal Business Name): 1800MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 BANNINGTON RD
CHARLOTTE NC
28226-1358
US

IV. Provider business mailing address

6408 BANNINGTON RD
CHARLOTTE NC
28226-1358
US

V. Phone/Fax

Practice location:
  • Phone: 704-247-9197
  • Fax:
Mailing address:
  • Phone: 704-247-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP SOLOMON
Title or Position: DIRECTOR
Credential:
Phone: 704-247-9197