Provider Demographics
NPI:1861482549
Name:GALENTINE, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:GALENTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2842
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8122
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
206849EMedicare PIN
NCB93338Medicare UPIN
NC206489EMedicare PIN