Individual
ELLEN MARIE KACZMAREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
310 LONG SHOALS RD, SUITE 310, ARDEN, NC 28704-8794
(828) 213-8235
Mailing address
PO BOX 602373, CHARLOTTE, NC 28260-2373
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200201376
NC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
200201376
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619914231
—
NC
Enumeration date
06/01/2006
Last updated
10/20/2015
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