MEDICARE: DR. JEFFREY G CARDWELL 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	207Q00000X	Family Medicine Physician	39769	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	:	1700848710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY G CARDWELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-510-8000
Fax Number	:	704-510-8006

Provider Business Practice Location Address
First Line	:	10816 BLACK DOG LN
Second Line	:	SUITE 160
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-1478
Country	:	US
Telephone Number	:	704-316-3970
Fax Number	:	704-316-3971

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	03/18/2015

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