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General NPI Number Information
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NPI Number | 1902101181
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Entity Type | Organization
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Legal Business Name | VAPOURMD, P.A.
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 340 RIVERWOOD RD
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City | MOORESVILLE
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State | NC
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Zip | 28117-8896
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Country | US
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Telephone | 704-928-5174
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Fax | 704-662-6946
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | SALISBURY
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State | NC
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Zip | 28145-0124
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Country | US
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Telephone | 704-469-8473
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Fax | 704-642-0529
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Authorized Official
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Title or Position | INCORPORATOR
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Name | JONATHAN N MCMULLEN
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Credential | M.D.
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Telephone | 704-928-5174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2005-01754
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License Number State | NC
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