Provider Demographics
NPI:1336583798
Name:PYFROM, NATASHA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEE
Last Name:PYFROM
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1656 RIVERCHASE BLVD
Practice Address - Street 2:STE 2400
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2084
Practice Address - Country:US
Practice Address - Phone:803-329-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336583798Medicaid
SC396146Medicaid
NC1336583798Medicaid