Provider Demographics
NPI:1588621387
Name:INTERNAL MEDICINE ASSOCIATES OF CHARLOTTE, P.A.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF CHARLOTTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACAMPORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-366-0080
Mailing Address - Street 1:8035 PROVIDENCE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9716
Mailing Address - Country:US
Mailing Address - Phone:704-366-0080
Mailing Address - Fax:
Practice Address - Street 1:8035 PROVIDENCE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9716
Practice Address - Country:US
Practice Address - Phone:704-366-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0182AOtherBCBS NC
NC790182AMedicaid
NC790182AMedicaid