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General NPI Number Information
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NPI Number | 1508180803
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Entity Type | Organization
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Legal Business Name | NORTH CHARLOTTE FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 2801 CRISMAN ST
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City | CHARLOTTE
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State | NC
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Zip | 28208-3847
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Country | US
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Telephone | 704-392-4108
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Fax | 704-392-4109
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Provider Business Mailing Address
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Address Line | 2801 CRISMAN ST
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City | CHARLOTTE
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State | NC
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Zip | 28208-3847
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Country | US
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Telephone | 704-392-4108
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Fax | 704-392-4109
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Authorized Official
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Title or Position | M.D./OWNER
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Name | DR. STEVEN SEWANYANA
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Credential | M.D.
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Telephone | 704-392-4108
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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 | 200500253
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License Number State | NC
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