Individual
CELIA B ENTWISTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 MEDICAL PARK DR STE 400, CONCORD, NC 28025-0939
(704) 786-1108
(704) 782-1826
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 638-9990
(704) 639-0785
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
36179
NC
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
36179
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046910802
—
TX
01
—
30701
BCBSNC
NC
05
—
89-30701
—
NC
01
—
930095201
RR MEDICARE
NC
05
—
N36179
—
SC
Enumeration date
05/11/2006
Last updated
10/13/2021
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