MEDICARE: POLINA CHERKEZ HARTLEY MSM, MMS, PA-C

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	363A00000X	Physician Assistant	0010-15733	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972491967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POLINA CHERKEZ HARTLEY MSM, MMS, PA-C

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	:	11300 CRESTHILL DR STE 100
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-7992
Country	:	US
Telephone Number	:	980-302-3550
Fax Number	:	980-302-3551

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	09/08/2025

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