=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578677712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOTINER FAMILY HEALTHCARE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 01/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 W MAIN ST
-----------------------------------------------------
City | ROCKWELL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28138-8471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-279-1046
-----------------------------------------------------
Fax | 704-279-1603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 W MAIN ST
-----------------------------------------------------
City | ROCKWELL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28138-8471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-279-1046
-----------------------------------------------------
Fax | 704-279-1603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. MARTIE E CHOTINER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-279-1046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------