Healthcare Provider Details

I. General information

NPI: 1841244589
Provider Name (Legal Business Name): CHARLOTTE HARVEY WEITZ PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S WILMINGTON ST
RICHLANDS NC
28574-8298
US

IV. Provider business mailing address

PO BOX 986513 DEPARTMENT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-324-7268
  • Fax: 910-324-7273
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number001000003
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000003
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: