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1811100142

NPI Code Detail

MEDICARE: PETERSON FORTUNATO GIALLANZA M.D.

MEDICARE: PETERSON FORTUNATO GIALLANZA 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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	200701902	NC
2	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	200701902	NC
3	2084N0400X	Neurology Physician	2007-01902	NC
4	2084N0600X	Clinical Neurophysiology Physician	200701902	NC
5	2084P0005X	Neurodevelopmental Disabilities Physician	200701902	NC
6	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	200701902	NC
7	2084V0102X	Vascular Neurology Physician	200701902	NC
8	2084N0400X	Neurology Physician	200701902	NC

General Provider Information

NPI Number	:	1811100142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETERSON FORTUNATO GIALLANZA M.D.

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

Provider Business Practice Location Address
First Line	:	10305 HAMPTONS PARK DR STE 101
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7221
Country	:	US
Telephone Number	:	704-316-5388
Fax Number	:	704-316-1848

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	03/10/2025

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Directions to “ PETERSON FORTUNATO GIALLANZA M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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