Provider Demographics
NPI:1841397866
Name:PAULINO, JORGE MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:MARTIN
Last Name:PAULINO
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 1:10111 WHITEBURN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6638
Mailing Address - Country:US
Mailing Address - Phone:704-527-5737
Mailing Address - Fax:704-900-2130
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-5514
Practice Address - Fax:704-384-5992
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201144207RG0300X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913256Medicaid
NC802471OtherPARTNERS MEDICARE
NC34D0242865OtherCLIA
NC34D0242865OtherCLIA
NCBP7580512OtherDEA
NC34D0242865OtherCLIA