GLEN FANDETTI (NPI# 1265656094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1265656094 |
Entity Type | Individual |
Full Name | GLEN FANDETTI |
Credential | MD |
Practice Address |
1900 Brunswick Ave Charlotte NC 28207-1822 |
Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
Practice Telephone | 7043041110 |
Enumeration Date | 2007-04-12 |
Last Update Date | 2020-09-25 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
2008-01700 | NC | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
10650 Park Rd, Ste 220, Charlotte, NC 282108538 | 7046673840 | |
1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 282035866 | 7043730212 | |
101 E W T Harris Blvd, Ste 1213, Charlotte, NC 282623485 | 7048631950 | |
16455 Statesville Rd, Ste 490, Huntersville, NC 280787135 | 7048631950 |
Street Address |
1900 BRUNSWICK AVE |
City | CHARLOTTE |
State | NC |
Zip Code | 28207-1822 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083652705 | Dominique Falewee | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2006-06-03 |
1457677247 | Mecklenburg Medical Group | Dermatology | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2010-04-19 |
1669797189 | Carolinas Physicians Network Inc | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2010-03-29 |
1144545583 | Mecklenburg Medical Group | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2010-03-29 |
1982793717 | Sarah Jane Massey | Nurse Practitioner | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2006-10-12 |
1922117191 | Kenneth D. Owen Jr. | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2006-08-30 |
1124061569 | Frank Valeri | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2006-06-14 |
1922041425 | William Bock | Internal Medicine | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2006-06-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
Find all providers in zip 28207 |
Taxonomy Code | 207RI0011X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Interventional Cardiology |
An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508364886 | Cardiac Cin of Charlotte LLC | Internal Medicine | 15720 Brixham Hill Ave Ste 300c, Charlotte, NC 28277-4784 | 2018-01-31 |
1114171634 | Novant Medical Group, Inc. | Internal Medicine | 125 Baldwin Avenue, Suite 200, Charlotte, NC 28204-3370 | 2008-11-11 |
1043433634 | Presbyterian Regional Healthcare Laboratory Services LLC | Internal Medicine | 1851 E 3rd St, Charlotte, NC 28204-3205 | 2007-04-11 |
1841290525 | Emmett C Mathews Jr. | Internal Medicine | 1928 Randolph Rd, Ste 215, Charlotte, NC 28207-1105 | 2005-07-26 |
1720590185 | Novant Medical Group, Inc | Internal Medicine | 8201 Healthcare Loop Ste 201, Charlotte, NC 28215-7072 | 2017-10-25 |
1790927820 | Jonathan Schwartz | Internal Medicine | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2009-04-06 |
1922111905 | Bryan Wilson | Internal Medicine | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2006-08-16 |
1891708939 | Michael Rinaldi | Internal Medicine | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2006-08-13 |
1184636532 | Glen Kowalchuk | Internal Medicine | 1001 Blythe Blvd, Ste 300- Adult Cardiology, Charlotte, NC 28203-5866 | 2006-08-13 |
1356353379 | John Cedarholm | Internal Medicine | 10650 Park Rd, Ste 220, Charlotte, NC 28210-8538 | 2006-08-12 |
Find all providers in CHARLOTTE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.