Provider Demographics
NPI:1508180803
Name:NORTH CHARLOTTE FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH CHARLOTTE FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWANYANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-392-4108
Mailing Address - Street 1:2801 CRISMAN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3847
Mailing Address - Country:US
Mailing Address - Phone:704-392-4108
Mailing Address - Fax:704-392-4109
Practice Address - Street 1:2801 CRISMAN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3847
Practice Address - Country:US
Practice Address - Phone:704-392-4108
Practice Address - Fax:704-392-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914149Medicaid