Provider Demographics
NPI:1326062761
Name:GOLEMBE, BARRY L (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:GOLEMBE
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 602120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:704-367-7400
Mailing Address - Fax:704-367-7555
Practice Address - Street 1:4501 CAMERON VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4297
Practice Address - Country:US
Practice Address - Phone:704-367-7400
Practice Address - Fax:704-367-7555
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23547208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36143OtherNCBCBS
NC8936143Medicaid
NC1326062761Medicaid
SC181457Medicaid
NC206687EMedicare PIN
NC206687CMedicare PIN
NC8936143Medicaid
NC1326062761Medicaid
NC206687FMedicare PIN
NC36143OtherNCBCBS