Individual
RYAN FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-9437
(704) 384-9440
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9437
(704) 384-9440
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
155465
CA
2084A2900X
Neurocritical Care Physician
Primary
2021-01709
NC
2084N0400X
Neurology Physician
2021-01709
NC
2084N0600X
Clinical Neurophysiology Physician
2021-01709
NC
Other
Enumeration date
04/16/2014
Last updated
02/14/2023
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