MECKLENBURG MEDICAL GROUP (NPI# 1386960342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386960342 |
| Entity Type | Organization |
| Organization Name | MECKLENBURG MEDICAL GROUP |
| Other Organization Name | MECKLENBURG MEDICAL GROUP (MMG) |
| Practice Address |
332 N Trade St Ste 2000 Matthews NC 28105-1728 |
| Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
| Practice Telephone | 7043028500 |
| Mailing Telephone | 7046310002 |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2020-08-31 |
| Authorized Official Name | THOMAS LAYMON (SENIOR VICE PRESIDENT) |
| Authorized Official Telephone | 7044468250 |
| Is Organization Subpart | Y |
| Parent Organization Name | MECKLENBURG MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RB0002X |
Internal Medicine Specialization: Obesity Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Mecklenburg Medical Group (MMG) | Doing Business As Name - Organization |
| Mecklenburg Medical Group (MMG) | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669797536 | Mecklenburg Medical Group | Internal Medicine | 16455 Statesville Road, Suite 200, Huntersville, NC 28078-7125 | 2010-04-02 |
| 1518282581 | Mecklenburg Medical Group | Internal Medicine | 7666 Charlotte Highway, Suite 200, Indian Land, SC 29707-7001 | 2010-04-02 |
| 1831414705 | Mecklenburg Medical Group | Internal Medicine | 10650 Park Road Extension, Suite 420, Charlotte, NC 28210-8539 | 2010-04-02 |
| 1780909101 | Mecklenburg Medical Group | Internal Medicine | 15110 John J Delaney Drive, Suite 200, Charlotte, NC 28277-3545 | 2010-03-29 |
| 1629305073 | Mecklenburg Medical Group | Internal Medicine | 13640 Steelecroft Parkway, Suite 320, Charlotte, NC 28278-7565 | 2009-11-05 |
| 1477879260 | Mecklenburg Medical Group | Dermatology | 4525 Cameron Valley Pkwy, Suite 2100, Charlotte, NC 28211-4369 | 2010-04-19 |
| 1821314618 | Mecklenburg Medical Group | Internal Medicine | 200 South College Street, Suite 500, Charlotte, NC 28202-2067 | 2010-04-19 |
| 1093031882 | Mecklenburg Medical Group | Internal Medicine | 16455 Statesville Rd, Ste 200, Huntersville, NC 28078-7135 | 2010-04-19 |
| 1457677247 | Mecklenburg Medical Group | Dermatology | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2010-04-19 |
| 1366768152 | Mecklenburg Medical Group | Dermatology | 1025 Morehead Medical Drive, Suite 200, Charlotte, NC 28204-2965 | 2010-04-19 |
| Street Address |
332 N TRADE ST STE 2000 |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28105-1728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689679714 | Tsz-ming Chow | Psychiatry & Neurology | 332 N Trade St, Suite 1200, Matthews, NC 28105-1728 | 2005-06-15 |
| 1679049977 | Jenna Pasquith | Nurse Practitioner | 332 N Trade St, Ste 2000, Matthews, NC 28105-1728 | 2018-10-15 |
| 1225425317 | Julio De Pena Fernandez | Internal Medicine | 332 N Trade St, Ste 2000, Matthews, NC 28105-1728 | 2015-04-16 |
| 1750779351 | Jessica Levy | Physician Assistant | 332 N Trade St, Suite 2000, Matthews, NC 28105-1728 | 2015-01-05 |
| 1427494913 | Bailey Chang | Internal Medicine | 332 N Trade St, Ste 2000, Matthews, NC 28105-1728 | 2013-05-11 |
| 1356784292 | Nicole Kosakowski | Physician Assistant | 332 N Trade St, Ste 1100, Matthews, NC 28105-1728 | 2013-04-10 |
| 1306176433 | Win Lin | Physician Assistant | 332 N Trade St, Ste 1100, Matthews, NC 28105-1728 | 2010-01-13 |
| 1083844666 | Rachael Collins | Physician Assistant | 332 N Trade St, Suite 1100, Matthews, NC 28105-1728 | 2009-07-17 |
| 1407005119 | Chanda Guptill | Nurse Practitioner | 332 N Trade St, Ste 1500, Matthews, NC 28105-1728 | 2008-09-17 |
| 1700079225 | Carolinas Physicians Network Inc | Internal Medicine | 332 N Trade St, Ste 1100, Matthews, NC 28105-1728 | 2007-08-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750917407 | Lauren Deasy Blackshaw | Counselor | 1163 Sam Newell Rd, Matthews, NC 28105 | 2020-03-13 |
| 1912549643 | Monarch | Community/Behavioral Health | 10545 Paces Avenue 634, Matthews, NC 28105 | 2019-10-15 |
| 1326515768 | Holly Harvey Heddleson | Nurse Practitioner | 1450 Matthews Township Pkwy Ste 280, Matthews, NC 28105 | 2018-10-24 |
| 1396241030 | Erickson Health Medical Group of North Carolina, PC | Internal Medicine | 2030 Windsor Run Lane, Matthews, NC 28105 | 2018-04-02 |
| 1811406994 | Lice Clinics of America of The Carolinas | Technician, Other | 3042 Suite C Senna Dr, Matthews, NC 28105 | 2017-09-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1568906055 | London Young | Physical Therapy Assistant | 11100- 11189 Berkley Square Ln, Charlotte, NC 28105 | 2016-12-19 |
| 1003363128 | New Beginnings Community Counseling Center | Community/Behavioral Health | 5232 Maragaret Wallace Road, Matthews, NC 28105 | 2016-09-07 |
| 1275993149 | Kristi Dougan | Nurse Practitioner | 434 N Trade St Ste 104, Matthews, NC 28105 | 2016-03-04 |
| 1205219896 | Kalyani Vellanki Starr | Dentist | 1819 Matthews Township Pkwy Ste 200, Matthews, NC 28105 | 2015-07-01 |
| Find all providers in zip 28105 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689644197 | Dermatology Associates of Charlotte | Dermatology | 101 E Matthews St, Suite 600, Matthews, NC 28105-4866 | 2006-01-25 |
| 1174743066 | Ronea Harris Chambers | Dermatology | 1450 Matthews Township Pkwy Ste 170, Matthews, NC 28105-6300 | 2007-04-26 |
| 1114960069 | Novant Medical Group, Inc. | Dermatology | 1450 Matthews Township Pkwy Ste 170, Matthews, NC 28105-6300 | 2006-06-14 |
| 1164496949 | John Reid | Dermatology | 1450 Matthews Township Pkwy Ste 170, Matthews, NC 28105-6300 | 2006-02-16 |
| 1629040985 | Jim A Rogers | Dermatology | 101 E Matthews St, Suite 600, Matthews, NC 28105-4866 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811128 | Foothills Family Dermatology | Dermatology | 118 North Sterling St, Morganton, NC 28655 | 2020-11-04 |
| 1316556871 | Easterm Dermatology, Pa | Dermatology | 1840 Nc Hwy 24, Newport, NC 28570 | 2020-07-30 |
| 1548878549 | Clara Dermatology | Dermatology | 7250 O'kelly Chapel Road, Suite 100, Cary, NC 27519 | 2020-07-16 |
| 1841837507 | Southeast Vulvar Clinic, Pllc | Dermatology | 6406 Carmel Road, Suite 309, Charlotte, NC 28226 | 2019-12-02 |
| 1205481009 | Novant Medical Group Inc | Dermatology | 6324 Fairview Rd # 200, Charlotte, NC 28210-3271 | 2019-08-08 |
| 1073172433 | Elaine Otchere | Dermatology | M145 Green Zone Duke South 40 Duke Medicine Circle, Durham, NC 27710-8267 | 2019-06-10 |
| 1902469570 | Falling Leaves Dermatology Mooresville LLC | Dermatology | 136 Corporate Park Dr Ste H, Mooresville, NC 28117-6960 | 2019-04-18 |
| 1669945259 | Claire Engel Holmquist | Dermatology | 11301 Golf Links Dr N Ste 203, Charlotte, NC 28277-8014 | 2019-01-07 |
| 1497227144 | Integrated Dermatology of North Carolina, Pllc | Dermatology | 10512 Park Rd Ste 113, Charlotte, NC 28210-8469 | 2018-12-19 |
| 1558848093 | Dermatology Consultants of Asheville Pllc | Dermatology | 218 Elkwood Ave # 104, Woodfin, NC 28804-2247 | 2018-07-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.