Healthcare Provider Details

I. General information

NPI: 1780282947
Provider Name (Legal Business Name): MATTHEW FRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1838
US

IV. Provider business mailing address

5401 ENVIRON WAY
CHAPEL HILL NC
27517-4472
US

V. Phone/Fax

Practice location:
  • Phone: 704-237-4240
  • Fax: 704-547-3150
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11177
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: