MEDICARE: DR. JENNIFER WHORLEY LASSITER 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	200601450	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1518078195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER WHORLEY LASSITER MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	844-266-8267
Fax Number	:

Provider Business Practice Location Address
First Line	:	6488 WEDDINGTON-MONROE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28104-6277
Country	:	US
Telephone Number	:	704-384-8460
Fax Number	:	704-384-1018

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/22/2023

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