Organization
CHARLOTTE PAIN ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY MARSHALL (OFFICE MANAGER)
(704) 364-7727
Entity
Organization
Contact information
Practice address
10504 PARK RD, SUITE 100, CHARLOTTE, NC 28210-8405
(704) 364-7727
(704) 367-9174
Mailing address
10504 PARK RD, SUITE 100, CHARLOTTE, NC 28210-8405
(704) 364-7727
(704) 367-9174
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01406
BLUE CROSS BLUE SHEILD
—
05
—
7901406
—
NC
Enumeration date
08/26/2005
Last updated
08/18/2010
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