Organization
METROLINA INTERNAL MEDICINE PA
Active
Organization
METROLINA INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE O'NEIL ELLIS MD (PRESIDENT)
(704) 372-9393
Entity
Organization
Contact information
Practice address
2300 RANDOLPH RD STE A, CHARLOTTE, NC 28207-1586
(704) 372-9393
(704) 372-0135
Mailing address
2300 RANDOLPH RD STE A, CHARLOTTE, NC 28207-1586
(704) 372-9393
(704) 372-0135
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
83588
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790278J
—
NC
Enumeration date
04/03/2006
Last updated
04/03/2018
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