Provider Demographics
NPI:1730100801
Name:CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC
Entity Type:Organization
Organization Name:CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-377-4009
Mailing Address - Street 1:2015 RANDOLPH RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1128
Mailing Address - Country:US
Mailing Address - Phone:704-377-4009
Mailing Address - Fax:704-815-1655
Practice Address - Street 1:2015 RANDOLPH RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1128
Practice Address - Country:US
Practice Address - Phone:704-377-4009
Practice Address - Fax:704-815-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2323686Medicare PIN