Provider Demographics
NPI:1033518915
Name:JOZEFARA, JOLANTA (MD)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:JOZEFARA
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 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-302-8700
Mailing Address - Fax:704-302-8701
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:SUITE 420
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8538
Practice Address - Country:US
Practice Address - Phone:704-302-8700
Practice Address - Fax:704-302-8701
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2016-0216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2904Medicaid
NC1033518915Medicaid
NCNCU692AMedicare PIN