Individual
DEBORAH G. AGISIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Mailing address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
200300546
NC
2085R0202X
Diagnostic Radiology Physician
23826
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154325553
RR MEDICARE (SC)
SC
05
—
89134EE
—
NC
05
—
N30546
—
SC
01
—
P00022677
RR MEDICARE (NC)
NC
Enumeration date
06/13/2005
Last updated
12/20/2017
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