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 601643, CHARLOTTE, NC 28260-1643
(704) 302-8000
(704) 302-8001
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5165580006
MEDICARE DME
NC
05
—
5903117
—
NC
01
—
7705294
MEDICAID DME
NC
05
—
E08621
—
SC
Enumeration date
04/19/2010
Last updated
06/20/2013
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