Healthcare Provider Details

I. General information

NPI: 1407894058
Provider Name (Legal Business Name): MDFAMILY MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CRISMAN ST
CHARLOTTE NC
28208-3847
US

IV. Provider business mailing address

2801 CRISMAN ST
CHARLOTTE NC
28208-3847
US

V. Phone/Fax

Practice location:
  • Phone: 704-393-1817
  • Fax: 704-393-9281
Mailing address:
  • Phone: 704-393-1817
  • Fax: 704-393-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MURPHY
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 704-527-6322