Healthcare Provider Details

I. General information

NPI: 1659307270
Provider Name (Legal Business Name): LINCOLN INTERNAL MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S. GENERALS BLVD.
LINCOLNTON NC
28092
US

IV. Provider business mailing address

P.O. BOX 70
LINCOLNTON NC
28093
US

V. Phone/Fax

Practice location:
  • Phone: 704-736-9188
  • Fax: 704-736-9667
Mailing address:
  • Phone: 704-736-9188
  • Fax: 704-736-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114730
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number114730
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number114730
License Number StateNC

VIII. Authorized Official

Name: DR. TOMA RADUT
Title or Position: PRESIDENT
Credential:
Phone: 704-736-9188