MEDICARE: PAULETTE C BRYANT M.D

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	200501171	NC
2	2080P0207X	Pediatric Hematology & Oncology Physician	200501171	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649268160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULETTE C BRYANT M.D

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-1900
Fax Number	:	704-384-1919

Provider Business Practice Location Address
First Line	:	301 HAWTHORNE LN
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2450
Country	:	US
Telephone Number	:	704-384-1900
Fax Number	:	704-384-1919

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/28/2020

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