Provider Demographics
NPI:1083652705
Name:FALEWEE, DOMINIQUE ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ANDRE
Last Name:FALEWEE
Suffix:
Gender:M
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E W T HARRIS BLVD
Practice Address - Street 2:STE 1213
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900830207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00612329OtherRAILROAD MEDICARE
NC1206TOtherBCBS
NC891206TMedicaid
NC1083652705Medicaid
SCQT9941Medicaid
NC2275718DMedicare PIN
NCP00612329OtherRAILROAD MEDICARE
NC1083652705Medicaid
NCNCE950AMedicare PIN
NC2275718CMedicare PIN
NC2275718BMedicare PIN