Provider Demographics
NPI:1164593604
Name:TROMBLEY, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:TROMBLEY
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 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-304-6400
Mailing Address - Fax:704-442-7021
Practice Address - Street 1:231 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2803
Practice Address - Country:US
Practice Address - Phone:704-304-6400
Practice Address - Fax:704-442-7021
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-019282084P0800X, 208000000X, 2084P0804X
OH35-0905232080P0204X
MS213912084P0800X, 2084P0804X
AL226892084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164593604Medicaid
SCNC2601Medicaid
NC1164593604Medicaid
NCNCM900DMedicare PIN
H71006Medicare UPIN
SCNC2601Medicaid
NCNCM900AMedicare PIN
NCNCM900EMedicare PIN