Individual
GLEN ANTHONY FANDETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 E W T HARRIS BLVD, STE 1213, CHARLOTTE, NC 28262-3485
(704) 863-1950
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008-01700
NC
207RC0000X
Cardiovascular Disease Physician
2008-01700
NC
207RI0011X
Interventional Cardiology Physician
Primary
2008-01700
NC
Other
Enumeration date
04/12/2007
Last updated
07/17/2024
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