Healthcare Provider Details

I. General information

NPI: 1225000953
Provider Name (Legal Business Name): PAVEENA POSANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/26/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 JAKE ALEXANDER BLVD W STE 303
SALISBURY NC
28147-1177
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-797-2442
  • Fax: 704-797-2443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9800360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: