Organization
MECKLENBURG MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS FORD LAYMON (SENIOR VICE PRESIDENT)
(704) 631-0002
Entity
Organization
Contact information
Practice address
4525 CAMERON VALLEY PKWY, SUITE 2100, CHARLOTTE, NC 28211-4369
(704) 302-8350
(704) 302-8351
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-8350
(704) 302-8351
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine 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
05
—
1477879260
—
NC
05
—
89013C0
—
NC
05
—
E08621
—
SC
Enumeration date
04/19/2010
Last updated
08/15/2016
Update your record
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