MECKLENBURG MEDICAL GROUP (NPI# 1558686188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558686188 |
| Entity Type | Organization |
| Organization Name | MECKLENBURG MEDICAL GROUP |
| Other Organization Name | MECKLENBURG MEDICAL GROUP (MMG) |
| Practice Address |
15110 John J Delaney Dr Ste 200 Charlotte NC 28277-3544 |
| Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
| Practice Telephone | 7043028100 |
| Mailing Telephone | 7046310002 |
| Enumeration Date | 2010-04-07 |
| 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 |
15110 JOHN J DELANEY DR STE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28277-3544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962407650 | Zuzana Banas | Internal Medicine | 15110 John J Delaney Dr, Ste 200, Charlotte, NC 28277-3544 | 2005-06-17 |
| 1316423957 | Kristina Olang | Nurse Practitioner | 15110 John J Delaney Dr, Ste 200, Charlotte, NC 28277-3544 | 2018-07-17 |
| 1912417627 | Elizabeth Aravapalli | Nurse Practitioner | 15110 John J Delaney Dr, Ste 100, Charlotte, NC 28277-3544 | 2017-10-08 |
| 1154872927 | Sydney Capodicasa | Nurse Practitioner | 15110 John J Delaney Dr, Ste 200, Charlotte, NC 28277-3544 | 2016-10-17 |
| 1760877716 | Jason Fishel | Family Medicine | 15110 John J Delaney Dr, Ste 200, Charlotte, NC 28277-3544 | 2015-04-06 |
| 1154753903 | Jennifer Crumpler | Advanced Practice Midwife | 15110 John J Delaney Dr, Ste 100, Charlotte, NC 28277-3544 | 2013-08-04 |
| 1932544293 | Tina Moreno | Advanced Practice Midwife | 15110 John J Delaney Dr, Ste 100, Charlotte, NC 28277-3544 | 2013-04-30 |
| 1770822769 | Tammy Reyes | Advanced Practice Midwife | 15110 John J Delaney Dr, Ste 100, Charlotte, NC 28277-3544 | 2013-02-11 |
| 1730441155 | Anne Lutin | Internal Medicine | 15110 John J Delaney Dr, Ste 200, Charlotte, NC 28277-3544 | 2012-06-12 |
| 1154609170 | Ifeoma Anulika Ilo | Nurse Practitioner | 15110 John J Delaney Dr, Suite 100, Charlotte, NC 28277-3544 | 2011-07-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255949731 | New Life Peer Support and Coaching LLC | Clinic/Center | 3450 Toringdon Way, Suite 200, Charlotte, NC 28277 | 2020-07-21 |
| 1083256762 | Speak Life Counseling Services, Pllc | Counselor | 16147 Lacaster Hwy, Suite 110, Charlotte, NC 28277 | 2019-10-14 |
| 1275010019 | Jigneshkumar R Mistry | Pharmacist | 11805 Allforth Ln Apt 2105, Charlotte, NC 28277 | 2018-07-24 |
| 1255825410 | Novant Medical Group Inc. | Family Medicine | 15033 Balloncroft Parkway, Suite 200, Charlotte, NC 28277 | 2018-06-20 |
| 1447752316 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 11135 Golf Links Dr, Charlotte, NC 28277 | 2018-03-06 |
| 1932607595 | Charlotte Proactive Md PC | Clinic/Center | 11220 Golf Links Drive North, Charlotte, NC 28277 | 2018-01-30 |
| 1003331521 | Accela Spine and Pain, Pllc | Anesthesiology | 10120 Ivey Chase Lane, Apt 617, Charlotte, NC 28277 | 2017-08-04 |
| 1265961619 | Dominicka Whitaker | Counselor | 12365 Bluestem Ln., Charlotte, NC 28277 | 2017-06-08 |
| 1083143408 | Monika D Hayes | Counselor | 11330 Snapfinger Drive, Charlotte, NC 28277 | 2017-06-08 |
| 1225582984 | Danielle Mcdaniel | Occupational Therapist | 5113 Piper Station Dr Ste 103, Charlotte, NC 28277 | 2016-08-11 |
| Find all providers in zip 28277 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 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 |
| 1770004376 | Laurel Castano | Dermatology | 10370 Park Rd Ste 201, Charlotte, NC 28210-8509 | 2017-07-05 |
| 1154732386 | Eileen Larkin Axibal | Dermatology | 15830 Ballantyne Medical Pl Ste 225, Charlotte, NC 28277-0760 | 2014-05-09 |
| 1013233352 | Alyssa Searles Daniel | Dermatology | 6324 Fairview Rd Ste 200, Charlotte, NC 28210-3361 | 2010-04-12 |
| 1538483078 | Scott Paviol | Dermatology | 2620 E 7th St Ste 200, Charlotte, NC 28204-4314 | 2010-03-25 |
| 1215050646 | Todd Helfman Md, Pa | Dermatology | 9335 Blakeney Centre Drive, Suite 130, Charlotte, NC 28277 | 2007-04-09 |
| 1346398435 | Novant Medical Group, Inc | Dermatology | 108 Providence Rd, Charlotte, NC 28207-1218 | 2007-01-08 |
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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.