Provider Demographics
NPI:1417941956
Name:WHITESIDES, PAUL C JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:WHITESIDES
Suffix:JR
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 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:910-579-8363
Mailing Address - Fax:910-579-8306
Practice Address - Street 1:75 EMERSON BAY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CAROLINA SHORES
Practice Address - State:NC
Practice Address - Zip Code:28467-2498
Practice Address - Country:US
Practice Address - Phone:910-579-8363
Practice Address - Fax:910-579-8306
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25968207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8987175Medicaid
NC110065492OtherRAILROAD MEDICARE
NC110065492OtherRAILROAD MEDICARE
NC8987175Medicaid