=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699200980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATARINA NOLAN RUAS REGO CANHA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2017
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1237 HARDING PLACE
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-446-2464
-----------------------------------------------------
Fax | 704-468-3237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 E 20TH ST
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28205-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-999-7540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 2024-02385
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------