MEDICARE: SHORELINE FAMILY MEDICINE, PC

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	207Q00000X	Family Medicine Physician		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	:	1558573527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORELINE FAMILY MEDICINE, PC

Provider Business Mailing Address
First Line	:	275 N HIGHWAY 16
Second Line	:	SUITE 104
City	:	DENVER
State	:	NC
Zip	:	28037-3000
Country	:	US
Telephone Number	:	704-489-0365
Fax Number	:	704-489-0351

Provider Business Practice Location Address
First Line	:	275 N HIGHWAY 16
Second Line	:	SUITE 104
City	:	DENVER
State	:	NC
Zip	:	28037-3000
Country	:	US
Telephone Number	:	704-489-0365
Fax Number	:	704-489-0351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VESNA TOMOVICH
Credential	:	MD
Telephone Number	:	704-489-0365

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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Directions to “SHORELINE FAMILY MEDICINE, PC ” Practice Location

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