Provider Demographics
NPI:1770587743
Name:FLEMING, SAMUEL BRYSON II (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BRYSON
Last Name:FLEMING
Suffix:II
Gender:M
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 63296
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3296
Mailing Address - Country:US
Mailing Address - Phone:828-258-8545
Mailing Address - Fax:844-378-7512
Practice Address - Street 1:10 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-258-8545
Practice Address - Fax:828-254-0714
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00805207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0080AMedicaid
NC32525OtherNC BLUE CROSS PROVIDER #
NC8932525Medicaid
NC32525OtherNC BLUE CROSS PROVIDER #
NC2226684Medicare UPIN
NC2226684Medicare PIN
NC32525OtherNC BLUE CROSS PROVIDER #