Provider Demographics
NPI:1043210099
Name:CORNERSTONE MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:CORNERSTONE MEDICAL CLINIC PC
Other - Org Name:CORNERSTONE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLINGTON
Authorized Official - Middle Name:I
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-551-0883
Mailing Address - Street 1:7704 ENGLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5954
Mailing Address - Country:US
Mailing Address - Phone:704-551-0883
Mailing Address - Fax:704-551-4114
Practice Address - Street 1:7704 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5954
Practice Address - Country:US
Practice Address - Phone:704-551-4151
Practice Address - Fax:704-551-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014VCMedicaid
NC2334622Medicare ID - Type Unspecified