Organization
CENTER FOR QUALITY OF LIFE ISSUES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYANN TRAXLER M.D. (OWNER)
(704) 540-0224
Entity
Organization
Contact information
Practice address
6429 BANNINGTON RD, STE B, CHARLOTTE, NC 28226-1344
(704) 540-0224
(704) 540-0694
Mailing address
6429 BANNINGTON RD, STE B, CHARLOTTE, NC 28226-1344
(704) 540-0224
(704) 540-0694
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9700784
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2247144A
P10 MEDICARE
NC
Enumeration date
05/11/2012
Last updated
05/11/2012
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