Provider Demographics
NPI:1881491421
Name:EMANUEL, GARY RICHARD
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:RICHARD
Last Name:EMANUEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 SLAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3336
Mailing Address - Country:US
Mailing Address - Phone:704-605-4504
Mailing Address - Fax:
Practice Address - Street 1:3609 SLAGLE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3336
Practice Address - Country:US
Practice Address - Phone:704-605-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20136367343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)