=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790949642
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER SUE GLADUE DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2008
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E MOREHEAD ST STE 100
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-3195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-342-0252
-----------------------------------------------------
Fax | 980-533-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7810 BALLANTYNE COMMONS PKWY STE 300
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-342-0252
-----------------------------------------------------
Fax | 980-533-7806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 2015-01003
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------