Provider Demographics
NPI:1073879060
Name:MARCONI, MICHAEL A (OPA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MARCONI
Suffix:
Gender:M
Credentials:OPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3541 RANDOLPH ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2886
Mailing Address - Country:US
Mailing Address - Phone:704-944-0143
Mailing Address - Fax:704-944-7399
Practice Address - Street 1:3541 RANDOLPH ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2886
Practice Address - Country:US
Practice Address - Phone:704-944-0143
Practice Address - Fax:704-944-7399
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1175363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical