Healthcare Provider Details

I. General information

NPI: 1386271930
Provider Name (Legal Business Name): IRINA MARIA GEICULESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

2219 CROSSCUT DR
CHARLOTTE NC
28214-7714
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-6850
  • Fax:
Mailing address:
  • Phone: 864-404-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number260863
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number260863
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: