Healthcare Provider Details

I. General information

NPI: 1831635598
Provider Name (Legal Business Name): TRI-COUNTY PULMONARY AND CRITICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 FORNEY CREEK PKWY STE 2200
DENVER NC
28037-9522
US

IV. Provider business mailing address

PO BOX 3246
MOORESVILLE NC
28117-3246
US

V. Phone/Fax

Practice location:
  • Phone: 704-951-8444
  • Fax: 704-360-9978
Mailing address:
  • Phone: 704-951-8444
  • Fax: 704-951-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRAG GUPTA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-938-6006