Provider Demographics
NPI:1225058282
Name:NORMAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:NORMAN
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 601884
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1884
Mailing Address - Country:US
Mailing Address - Phone:980-487-2100
Mailing Address - Fax:704-482-8779
Practice Address - Street 1:709 N DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3911
Practice Address - Country:US
Practice Address - Phone:980-487-2100
Practice Address - Fax:704-482-8779
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-37914208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC63198OtherNCBCBS
NC1225058282Medicaid
SCN37914Medicaid
NC8963198Medicaid
NC63198OtherNCBCBS