Provider Demographics
NPI:1760618243
Name:HEMPHILL, IRMANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMANIE
Middle Name:
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRMANIE
Other - Middle Name:
Other - Last Name:ELIACIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5014 TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8853
Mailing Address - Country:US
Mailing Address - Phone:305-310-2251
Mailing Address - Fax:704-628-5936
Practice Address - Street 1:1640 CAMPUS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5284
Practice Address - Country:US
Practice Address - Phone:704-340-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13485207Q00000X
NC2015-02115207Q00000X
SCMD51757207Q00000X
FLME108465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9529OtherMEDICARE GROUP NUMBER
FL14H8VOtherBCBS OF FLORIDA
FL1760618243OtherTRICARE
1457376352OtherRAHN SHAW MD PA GROUP NPI
FL2844337OtherCIGNA
FL592696120OtherRAHN SHAW MD PA TAX IDENTIFICATION
FL004152400Medicaid
FL592696120OtherRAHN SHAW MD PA TAX IDENTIFICATION