Provider Demographics
NPI:1457799934
Name:PILIGIAN, AMANDA JOANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOANNE
Last Name:PILIGIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOANNE
Other - Last Name:KALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6817 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3484
Mailing Address - Country:US
Mailing Address - Phone:704-323-5090
Mailing Address - Fax:
Practice Address - Street 1:6817 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3484
Practice Address - Country:US
Practice Address - Phone:704-323-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031484363A00000X
MA363A00000X
DEC5-0001001363AM0700X
NC001011045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical