Organization
CHARLOTTE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L. WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
10545 BLAIR ROAD, SUITE 2100, MINT HILL, NC 28227-2804
(704) 863-9500
(704) 863-9501
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 512-4808
(704) 512-4838
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5908921
—
NC
Enumeration date
12/17/2009
Last updated
10/24/2012
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