Organization
CHARLOTTE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
1001 BLYTHE BLVD, MCP SUITE 500, CHARLOTTE, NC 28203-5874
(704) 355-5100
(704) 355-5180
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 355-5100
(704) 342-4354
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012Y0
—
NC
Enumeration date
07/12/2006
Last updated
09/09/2008
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