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General NPI Number Information
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NPI Number | 1215911169
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Entity Type | Organization
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Legal Business Name | NORTHCROSS MEDICAL CENTER PC
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16511 A NORTHCROSS DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5021
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Country | US
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Telephone | 704-896-3313
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Fax | 704-896-8193
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Provider Business Mailing Address
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Address Line | 17705 SPRING WINDS DR
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City | CORNELIUS
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State | NC
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Zip | 28031-7744
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Country | US
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Telephone | 704-896-3313
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Fax | 704-896-8193
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK TUAN LE
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Credential | MD
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Telephone | 704-896-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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