Provider Demographics
NPI:1225000953
Name:POSANG, PAVEENA (MD)
Entity Type:Individual
Prefix:
First Name:PAVEENA
Middle Name:
Last Name:POSANG
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1904 JAKE ALEXANDER BLVD W STE 303
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1177
Practice Address - Country:US
Practice Address - Phone:704-797-2442
Practice Address - Fax:704-797-2443
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800360207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1135QOtherBCBS
NC1225000953Medicaid
NC891127XMedicaid
NC2255495AMedicare PIN
NCNCI1770386Medicare PIN
NCNCI177CMedicare PIN
NCNCI177EMedicare PIN
2255495Medicare PIN
NCNCI177AMedicare PIN
G83071Medicare UPIN
NC1225000953Medicaid
VAVV4519AMedicare PIN
NCNCI177BMedicare PIN