Provider Demographics
NPI:1700848710
Name:CARDWELL, JEFFREY G (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-510-8000
Mailing Address - Fax:704-510-8006
Practice Address - Street 1:10816 BLACK DOG LN
Practice Address - Street 2:SUITE 160
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-1478
Practice Address - Country:US
Practice Address - Phone:704-316-3970
Practice Address - Fax:704-316-3971
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920658Medicaid
NC8920658Medicaid
NC2159209GMedicare PIN