Healthcare Provider Details

I. General information

NPI: 1205815701
Provider Name (Legal Business Name): ID CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 HEDGEMORE DRIVE SUITE 100
CHARLOTTE NC
28209
US

IV. Provider business mailing address

4539 HEDGEMORE DRIVE SUITE 100
CHARLOTTE NC
28209
US

V. Phone/Fax

Practice location:
  • Phone: 704-331-9669
  • Fax: 704-688-0035
Mailing address:
  • Phone: 704-331-9669
  • Fax: 704-688-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LEWIS H MCCURDY III
Title or Position: PRESIDENT
Credential: MD
Phone: 704-331-9669