Individual
DR. AVICK G MITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 MOREHEAD MEDICAL DR, SUITE 500, 5TH FLOOR, CHARLOTTE, NC 28204-2963
(704) 355-3149
(704) 355-5891
Mailing address
PO BOX 601372, CHARLOTTE, NC 28260-1372
(704) 355-3149
(704) 355-5891
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
32018
NC
207VM0101X
Maternal & Fetal Medicine Physician
Primary
32018
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396750857
—
NC
01
—
59819
BCBS NC
NC
05
—
8959819
—
NC
05
—
N32018
—
SC
Enumeration date
07/30/2006
Last updated
05/08/2014
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