Organization
MECKLENBURG MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 335-0648
Entity
Organization
Contact information
Practice address
10650 PARK ROAD EXTENSION, SUITE 420, CHARLOTTE, NC 28210-8539
(704) 302-8700
(704) 302-8701
Mailing address
PO BOX 60063, CHARLOTTE, NC 28260-0063
(704) 302-8700
(704) 302-8701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/02/2010
Last updated
04/02/2010
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