Organization
MECKLENBURG MEDICAL GROUP
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
1025 MOREHEAD MEDICAL DRIVE, SUITE 200, CHARLOTTE, NC 28204-2965
(704) 302-8000
(704) 302-8001
Mailing address
PO BOX 60063, CHARLOTTE, NC 28260-0063
(704) 302-8000
(704) 302-8001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/02/2010
Last updated
04/02/2010
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