Provider Demographics
NPI:1508386640
Name:FIRST MED PC
Entity Type:Organization
Organization Name:FIRST MED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NDI
Authorized Official - Middle Name:JOHNNIE
Authorized Official - Last Name:MADUAKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-849-8385
Mailing Address - Street 1:8022 PROVIDENCE RD STE 500-119
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9719
Mailing Address - Country:US
Mailing Address - Phone:516-849-8385
Mailing Address - Fax:516-830-3520
Practice Address - Street 1:1795 DR FRANK GASTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1190
Practice Address - Country:US
Practice Address - Phone:516-849-8385
Practice Address - Fax:516-830-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD37960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty