MEDICARE: INTERNAL MEDICINE ASSOCIATES OF GASTONIA PA

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	207R00000X	Internal Medicine Physician	9800159	NC

General Provider Information

NPI Number	:	1528190410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF GASTONIA PA

Provider Business Mailing Address
First Line	:	2391 COURT DR STE 110
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	704-853-3330
Fax Number	:	704-853-8951

Provider Business Practice Location Address
First Line	:	2391 COURT DR STE 110
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	704-853-3330
Fax Number	:	704-853-8951

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAIME VILLARREAL
Credential	:	M.D.
Telephone Number	:	704-853-3330

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	06/23/2013

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