Healthcare Provider Details

I. General information

NPI: 1093081762
Provider Name (Legal Business Name): NEW HOPE SPECIALTY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 LATROBE DR
CHARLOTTE NC
28211-4849
US

IV. Provider business mailing address

3101 LATROBE DR
CHARLOTTE NC
28211-4849
US

V. Phone/Fax

Practice location:
  • Phone: 704-817-8331
  • Fax: 704-817-8795
Mailing address:
  • Phone: 704-817-8331
  • Fax: 704-817-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number200100821
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200100821
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number200100821
License Number StateNC

VIII. Authorized Official

Name: KURIAN CHIRAMEL ABRAHAM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 704-817-8331