MEDICARE: DR. MAURICIO VALENCIA 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	226973	NY
2	207Q00000X	Family Medicine Physician	2091914	SC

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	:	1962453647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICIO VALENCIA 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	:	6237 CAROLINA COMMONS DR STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-4511
Country	:	US
Telephone Number	:	803-548-9393
Fax Number	:	803-548-9590

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/12/2024

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