Provider Demographics
NPI:1467478990
Name:SCOBEY, MARTIN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:WILLIAM
Last Name:SCOBEY
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28339207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467478990Medicaid
NC74995OtherNCBCBS
NC8974995Medicaid
SCN28339Medicaid
NC74995OtherBCBS
SCN28339Medicaid
NC8974995Medicaid
NC100009663Medicare PIN
NC100015792Medicare PIN
NCNCQ034AMedicare PIN
NC210254DMedicare PIN
NC1467478990Medicaid