Provider Demographics
NPI:1902358294
Name:INTEGRATIVE RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:WITHERS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:919-475-9243
Mailing Address - Street 1:10826 MALLARD CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-7785
Mailing Address - Country:US
Mailing Address - Phone:704-774-3044
Mailing Address - Fax:704-774-3045
Practice Address - Street 1:10826 MALLARD CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7785
Practice Address - Country:US
Practice Address - Phone:704-774-3044
Practice Address - Fax:704-774-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01881207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902358294Medicaid
NC1902358294Medicaid