Provider Demographics
NPI:1497775829
Name:HERBERT, ALLISON C (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:HERBERT
Suffix:
Gender:F
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 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-302-8200
Mailing Address - Fax:704-302-8201
Practice Address - Street 1:3030 RANDOLPH RD
Practice Address - Street 2:SUITE 200, MMG MUSEUM
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1368
Practice Address - Country:US
Practice Address - Phone:704-302-8200
Practice Address - Fax:704-302-8201
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497775829Medicaid
NC5905525Medicaid
SCNC1564Medicaid
NC1497775829Medicaid
SCNC1564Medicaid
NC2061731Medicare PIN
NC2061731AMedicare PIN