Provider Demographics
NPI:1245208628
Name:ECHTERLING, SUSAN C (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:ECHTERLING
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 1:7108 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8371
Mailing Address - Country:US
Mailing Address - Phone:704-542-2191
Mailing Address - Fax:704-542-4243
Practice Address - Street 1:7108 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8371
Practice Address - Country:US
Practice Address - Phone:704-542-2191
Practice Address - Fax:704-542-4243
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001027869207P00000X
NC9600903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930129Medicaid
P00196139OtherRAILROAD MEDICARE
P00196139OtherRAILROAD MEDICARE
2233624FMedicare ID - Type Unspecified
NC8930129Medicaid