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NPI Code Detail

MEDICARE: DEBORAH G. AGISIM M.D.

MEDICARE: DEBORAH G. AGISIM M.D.
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
12085R0202XDiagnostic Radiology Physician23826SC
22085R0202XDiagnostic Radiology Physician200300546NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00022677OTHERNCRR MEDICARE (NC)
41154325553OTHERSCRR MEDICARE (SC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154325553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH G. AGISIM M.D.
Provider Business Mailing Address
First Line : 700 E MOREHEAD ST
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28202-2788
Country : US
Telephone Number : 704-334-7800
Fax Number : 704-414-7512
Provider Business Practice Location Address
First Line : 700 E MOREHEAD ST
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28202-2788
Country : US
Telephone Number : 704-334-7800
Fax Number : 704-414-7512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 12/20/2017

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Directions to “ DEBORAH G. AGISIM M.D.” Practice Location

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