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NPI Code Detail

MEDICARE: KASEY WYMER SCANNELL MD

MEDICARE: KASEY WYMER SCANNELL 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
1208000000XPediatrics Physician2009-00726NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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 : 1194853457
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY WYMER SCANNELL MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6010 CARNEGIE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4637
Country : US
Telephone Number : 704-384-9966
Fax Number : 704-384-9967
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 10/25/2020

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Directions to “ KASEY WYMER SCANNELL MD” Practice Location

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