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General NPI Number Information
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NPI Number | 1407035025
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Entity Type | Organization
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Legal Business Name | CAROMONT MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 14035 GRANDIFLORA DRIVE STE B
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City | CHARLOTTE
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State | NC
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Zip | 28278-8456
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Country | US
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Telephone | 704-583-1155
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Fax | 704-504-2495
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Provider Business Mailing Address
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Address Line | 14035 GRANDIFLORA DRIVE STE B
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City | CHARLOTTE
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State | NC
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Zip | 28278-8456
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Country | US
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Telephone | 704-583-1155
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Fax | 704-504-2495
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Authorized Official
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Title or Position | VP PRACTICE MANAGEMENT
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Name | CRAIG A DUNKER
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Credential |
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Telephone | 704-834-2135
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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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