Provider Demographics
NPI:1245224534
Name:WHITEHEAD, MARJORIE MCDOWELL (PA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MCDOWELL
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PA
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:704-537-0020
Mailing Address - Fax:704-316-8634
Practice Address - Street 1:7110 LAWYERS RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3906
Practice Address - Country:US
Practice Address - Phone:704-537-0020
Practice Address - Fax:704-316-8634
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102169207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101448Medicaid
NC8101448Medicaid
NC2744239BMedicare PIN