Healthcare Provider Details

I. General information

NPI: 1083698005
Provider Name (Legal Business Name): GIANNA DEMOS MADRID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIANNA DEMOS M.D.

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 WELTON WAY STE C
MOORESVILLE NC
28117-9163
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-2552
  • Fax: 704-664-5382
Mailing address:
  • Phone: 844-266-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number200000529
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200000529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: