Healthcare Provider Details

I. General information

NPI: 1154364867
Provider Name (Legal Business Name): MARTIMBEAU GYNECOLOGIC ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD STE 202
CHARLOTTE NC
28211
US

IV. Provider business mailing address

330 BILLINGSLEY RD STE 202
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-8644
  • Fax: 704-358-1466
Mailing address:
  • Phone: 704-334-8644
  • Fax: 704-358-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number24267
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number24267
License Number StateNC

VIII. Authorized Official

Name: DR. PIERRE W MARTIMBEAU
Title or Position: MD PRESIDENT
Credential: MD
Phone: 704-334-8644