Provider Demographics
NPI:1932187820
Name:SHRAGA, JONATHAN ABRAM (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ABRAM
Last Name:SHRAGA
Suffix:
Gender:M
Credentials:DO
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:SUITE 255
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101278207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891340RMedicaid
NC1340ROtherBCBS PROVIDER ID
SCN01278Medicaid
NC1932187820Medicaid
NC2023340HMedicare PIN
NC1932187820Medicaid
NC891340RMedicaid
NC2023340JMedicare PIN
NC2023340LMedicare PIN
SCN01278Medicaid
NCNC1043C904Medicare PIN
NC1340ROtherBCBS PROVIDER ID
NCNC1043AMedicare PIN
NC232009OtherMEDICARE PTAN, GROUP