Healthcare Provider Details

I. General information

NPI: 1922037076
Provider Name (Legal Business Name): ELAINE GRAMMER-PACICCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 PROVIDENCE RD SUITE 203
CHARLOTTE NC
28226-2952
US

IV. Provider business mailing address

PO BOX 60099
CHARLOTTE NC
28260-0099
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-2610
  • Fax: 704-543-6773
Mailing address:
  • Phone: 704-512-2610
  • Fax: 704-543-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9500598
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: