MEDICARE: CHARLOTTE CARDIOLOGY ASSOCIATES, P.A

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	174400000X	Specialist

General Provider Information

NPI Number	:	1528279510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE CARDIOLOGY ASSOCIATES, P.A

Provider Business Mailing Address
First Line	:	PO BOX 222067
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28222-2067
Country	:	US
Telephone Number	:	704-944-1135
Fax Number	:	704-944-1155

Provider Business Practice Location Address
First Line	:	309 S SHARON AMITY RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2886
Country	:	US
Telephone Number	:	704-944-1135
Fax Number	:	704-944-1155

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. THOMAS NANCE
Credential	:
Telephone Number	:	704-944-1135

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	11/09/2007

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