Healthcare Provider Details

I. General information

NPI: 1598976565
Provider Name (Legal Business Name): CHARLOTTE CARDIOLOGY ASSOCIATES P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 E FRANKLIN ST
MONROE NC
28112-5266
US

IV. Provider business mailing address

PO BOX 222067
CHARLOTTE NC
28222-2067
US

V. Phone/Fax

Practice location:
  • Phone: 704-283-6953
  • Fax: 704-283-0228
Mailing address:
  • Phone: 704-944-1135
  • Fax: 704-944-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS NANCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-944-1135