Provider Demographics
NPI:1750333779
Name:PANZETER, EDWARD SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:PANZETER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 604350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10030 GILEAD RD STE 245
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-895-9390
Practice Address - Fax:704-464-5948
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076372P208600000X
NC2017-00095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750333779Medicaid
OH4053171Medicare ID - Type Unspecified
NC1750333779Medicaid