Provider Demographics
NPI:1346376423
Name:BAMBINI, DANIEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:BAMBINI
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 1:1900 RANDOLPH RD.
Mailing Address - Street 2:STE. 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:27207-1106
Mailing Address - Country:US
Mailing Address - Phone:704-370-0223
Mailing Address - Fax:704-370-0799
Practice Address - Street 1:1900 RANDOLPH RD.
Practice Address - Street 2:STE. 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1106
Practice Address - Country:US
Practice Address - Phone:704-370-0223
Practice Address - Fax:704-370-0799
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912806Medicaid
SCN00300Medicaid
NCH42089Medicare UPIN
NC8912806Medicaid