Healthcare Provider Details

I. General information

NPI: 1184111577
Provider Name (Legal Business Name): JORGE ISAACS CONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 QUEENS RD STE 200
CHARLOTTE NC
28204-3578
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-343-9800
  • Fax: 704-347-2011
Mailing address:
  • Phone: 704-343-9800
  • Fax: 704-347-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2024-01282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: