Provider Demographics
NPI:1760024749
Name:WELLCOMEMD CHARLOTTE CLINIC, INC
Entity Type:Organization
Organization Name:WELLCOMEMD CHARLOTTE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ACAMPORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-444-0999
Mailing Address - Street 1:2500 GASKINS RD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1480
Mailing Address - Country:US
Mailing Address - Phone:804-774-7099
Mailing Address - Fax:804-528-5864
Practice Address - Street 1:8035 PROVIDENCE RD STE 315
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8909
Practice Address - Country:US
Practice Address - Phone:704-444-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6587H342Medicaid