Healthcare Provider Details

I. General information

NPI: 1962542365
Provider Name (Legal Business Name): LLOYD AUSTIN AARON RUNSER MD, MPH, FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19485 OLD JETTON RD STE 100 SUITE 100
CORNELIUS NC
28031-6583
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5170
  • Fax:
Mailing address:
  • Phone: 704-316-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-02471
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23944
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: