Healthcare Provider Details

I. General information

NPI: 1679700843
Provider Name (Legal Business Name): NEW HOPE MEDICAL CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 S NEW HOPE RD STE 1
GASTONIA NC
28056
US

IV. Provider business mailing address

3670 S NEW HOPE RD STE 1
GASTONIA NC
28056-8597
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-4560
  • Fax: 704-824-4560
Mailing address:
  • Phone: 704-709-3239
  • Fax: 704-478-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17583
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9300173
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KONRAD HELMUT KAEDING
Title or Position: MANAGER
Credential:
Phone: 302-518-3022