Provider Demographics
NPI:1831148485
Name:MCELGUNN, PATRICK SHANE (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:SHANE
Last Name:MCELGUNN
Suffix:
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 1:1072 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7498
Mailing Address - Country:US
Mailing Address - Phone:704-671-1094
Mailing Address - Fax:704-671-1095
Practice Address - Street 1:5815 BLAKENEY PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5732
Practice Address - Country:US
Practice Address - Phone:704-542-2220
Practice Address - Fax:704-542-3304
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD058240207N00000X
NC200600105207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903244Medicaid
NC5903244Medicaid
NC2052812Medicare PIN