Provider Demographics
NPI:1760461529
Name:BARTELT, PERRY LESTER (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LESTER
Last Name:BARTELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:PO BOX 1845
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4353
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-873-4511
Practice Address - Street 1:276 OLD MOCKSVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1949
Practice Address - Country:US
Practice Address - Phone:704-878-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6913595Medicaid
NC2287203BMedicare ID - Type Unspecified
NCC82719Medicare UPIN
NC6913595Medicaid