KREFT, WILLIAM DAVID (PA)

Provider Demographics

• NPI: 1760491823
• Name: KREFT, WILLIAM DAVID (PA)
• Entity Type: Individual
• First Name: WILLIAM
• Middle Name: DAVID
• Last Name: KREFT
• Gender: M
• Credentials: PA
• Mailing Address - Street 1: 16147 LANCASTER HWY
• Mailing Address - Street 2: STE 140
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28277-4782
• Mailing Address - Country: US
• Mailing Address - Phone: 704-208-4134
• Mailing Address - Fax: 704-208-8068
• Practice Address - Street 1: 309 S SHARON AMITY RD
• Practice Address - Street 2: SUITE 100
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28211-2886
• Practice Address - Country: US
• Practice Address - Phone: 704-446-2360
• Practice Address - Fax: 704-366-3746
• Is Sole Proprietor?: No
• Enumeration Date: 2006-08-07
• Last Update Date: 2018-10-11

Provider Licenses

State	License ID	Taxonomies
NC	103119	363A00000X, 207Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	8103161	Medicaid
NC	1760491823	Medicaid
SC	2257PA	Medicaid
NC	2758525B	Medicare PIN
	MK0645486	Medicare UPIN
NC	8103161	Medicaid
NC	2758525A	Medicare PIN
NC	2758525F	Medicare PIN
NC	2758525J	Medicare PIN
NC	2758525M	Medicare PIN
NC	2758525	Medicare PIN
NC	2758525N	Medicare PIN
NC	1760491823	Medicaid
NC	2758525D	Medicare PIN
SC	2257PA	Medicaid
NC	2758525E	Medicare PIN
NC	2758525G	Medicare PIN
NC	2758525C	Medicare PIN
NC	2758525K	Medicare PIN
NC	2758525R	Medicare PIN