Healthcare Provider Details

I. General information

NPI: 1548829542
Provider Name (Legal Business Name): MICHAEL AMBROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 MOCKSVILLE AVE
SALISBURY NC
28144-2732
US

IV. Provider business mailing address

501 S SHARON AMITY RD STE 300
CHARLOTTE NC
28211-0035
US

V. Phone/Fax

Practice location:
  • Phone: 704-210-5000
  • Fax:
Mailing address:
  • Phone: 704-377-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2021-02790
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: