Provider Demographics
NPI:1851362503
Name:PIEDMONT ADULT & PEDIATRIC MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:PIEDMONT ADULT & PEDIATRIC MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-865-0626
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:STE 204
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2142
Mailing Address - Country:US
Mailing Address - Phone:704-865-0626
Mailing Address - Fax:704-865-6531
Practice Address - Street 1:640 SUMMIT CROSSING PL
Practice Address - Street 2:STE 204
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2142
Practice Address - Country:US
Practice Address - Phone:704-865-0626
Practice Address - Fax:704-865-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012MGMedicaid
NC2344805Medicare PIN