=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194784793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA J. GIRARD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2006
-----------------------------------------------------
Last Update Date | 12/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HAWTHORNE LN
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-384-4188
-----------------------------------------------------
Fax | 704-384-5299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 QUEENS RD SUITE 400
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-333-7376
-----------------------------------------------------
Fax | 704-333-3397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 32436
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 15218
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------