Provider Demographics
NPI:1831635598
Name:TRI-COUNTY PULMONARY AND CRITICAL CARE PLLC
Entity Type:Organization
Organization Name:TRI-COUNTY PULMONARY AND CRITICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-938-6006
Mailing Address - Street 1:PO BOX 3246
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3246
Mailing Address - Country:US
Mailing Address - Phone:704-951-8444
Mailing Address - Fax:704-951-8440
Practice Address - Street 1:1585 FORNEY CREEK PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9522
Practice Address - Country:US
Practice Address - Phone:704-951-8444
Practice Address - Fax:704-360-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X, 261QM2500X
NC200401220207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty