Healthcare Provider Details

I. General information

NPI: 1457843757
Provider Name (Legal Business Name): CYRIL BOBBY MAZHUVANCHERY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1180
US

IV. Provider business mailing address

3426 TORINGDON WAY STE 108
CHARLOTTE NC
28277-3497
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7974
  • Fax: 704-372-8201
Mailing address:
  • Phone: 704-372-7974
  • Fax: 704-970-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2025-00807
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025-00807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: