Provider Demographics
NPI:1922037076
Name:GRAMMER-PACICCO, ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:GRAMMER-PACICCO
Suffix:
Gender:F
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:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-512-2610
Mailing Address - Fax:704-543-6773
Practice Address - Street 1:7800 PROVIDENCE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2952
Practice Address - Country:US
Practice Address - Phone:704-512-2610
Practice Address - Fax:704-543-6773
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2007475OtherAETNA
SCN00598Medicaid
NC64740OtherBCBS
NC8964740Medicaid
SCN00598Medicaid