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General NPI Number Information
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NPI Number | 1306175476
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Entity Type | Organization
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Legal Business Name | MECKLENBURG MEDICAL GROUP
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 1550 FAULK ST SUITE 1500
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City | MONROE
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State | NC
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Zip | 28112-5086
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Country | US
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Telephone | 704-302-9700
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Fax | 704-302-9701
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Provider Business Mailing Address
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Address Line | PO BOX 601643
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City | CHARLOTTE
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State | NC
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Zip | 28260-1643
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Country | US
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Telephone | 704-302-9700
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Fax | 704-302-9701
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. THOMAS FORD LAYMON
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Credential |
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Telephone | 704-631-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NC
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