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NPI Code Detail

MEDICARE: MR. PETER JEFFREY EWERT PHD

MEDICARE: MR. PETER JEFFREY EWERT PHD
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
1103G00000XClinical Neuropsychologist1548NC

General Provider Information

NPI Number : 1730188020
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER JEFFREY EWERT PHD
Provider Business Mailing Address
First Line : 6853 FAIRVIEW RD
Second Line : STE B
City : CHARLOTTE
State : NC
Zip : 28210-3363
Country : US
Telephone Number : 704-366-9930
Fax Number : 704-366-9931
Provider Business Practice Location Address
First Line : 6853 FAIRVIEW RD
Second Line : STE B
City : CHARLOTTE
State : NC
Zip : 28210-3363
Country : US
Telephone Number : 704-366-9930
Fax Number : 704-366-9931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/08/2007

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