MEDICARE: WENDY L MARLOW P.A.

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	363AM0700X	Medical Physician Assistant	102387	NC

General Provider Information

NPI Number	:	1952471146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY L MARLOW P.A.

Provider Business Mailing Address
First Line	:	1900 RANDOLPH RD
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1122
Country	:	US
Telephone Number	:	704-384-9113
Fax Number	:	704-316-0508

Provider Business Practice Location Address
First Line	:	8810 BLAKENEY PROFESSIONAL DR
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6595
Country	:	US
Telephone Number	:	704-759-8188
Fax Number	:	704-759-0857

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/07/2023

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