Provider Demographics
NPI:1326050725
Name:UTOH, JANCY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JANCY
Middle Name:F
Last Name:UTOH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6801 SOUTH BLVD STE D&E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4458
Mailing Address - Country:US
Mailing Address - Phone:704-451-9679
Mailing Address - Fax:704-643-7295
Practice Address - Street 1:644 CLARK DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3714
Practice Address - Country:US
Practice Address - Phone:980-212-2680
Practice Address - Fax:980-212-2690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC28391208000000X
NC2005-01936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC283912Medicaid
NC5902894Medicaid
SC283912Medicaid