MEDICARE: ROXANNE DENISE SEMPLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2005-01801	NC

General Provider Information

NPI Number	:	1083636104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE DENISE SEMPLE MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9908 COULOAK DR
Second Line	:	STE 103
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8678
Country	:	US
Telephone Number	:	704-801-2025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/15/2024

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