Provider Demographics
NPI:1780968131
Name:UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-687-7418
Mailing Address - Street 1:9201 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28223-0001
Mailing Address - Country:US
Mailing Address - Phone:704-687-7400
Mailing Address - Fax:
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4585261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health