Provider Demographics
NPI:1023018082
Name:IMPERIAL, EVA A (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:A
Last Name:IMPERIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896199
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6199
Mailing Address - Country:US
Mailing Address - Phone:980-223-2378
Mailing Address - Fax:
Practice Address - Street 1:114 GATEWAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5598
Practice Address - Country:US
Practice Address - Phone:980-435-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22642207Q00000X
NC2010-01472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL36224Medicaid
H977284350Medicare ID - Type Unspecified
H97728Medicare UPIN