Individual
PEDRO CERVANTES FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13532 STEELECROFT PARKWAY, CHARLOTTE, NC 28278-7545
(704) 295-3475
(704) 295-3476
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
(704) 295-3476
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036129100
IL
207W00000X
Ophthalmology Physician
Primary
2016-01762
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19N11
BCBSNC
NC
01
—
7151944
CIGNA
—
01
—
9973753
AETNA
—
05
—
NC2885
—
SC
01
—
P01840923
RAILROAD MEDICARE
NC
Enumeration date
10/07/2008
Last updated
04/27/2021
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