GLEN FANDETTI


Address: 1900 Brunswick Ave, Charlotte, NC 28207-1822
Phone: 7043041110

GLEN FANDETTI (NPI# 1265656094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RI0011X Internal Medicine
Specialization: Interventional Cardiology
2008-01700 NC Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

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

Office Location

Street Address 1900 BRUNSWICK AVE
City CHARLOTTE
State NC
Zip Code 28207-1822

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 207RI0011X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Interventional Cardiology

Taxonomy Definition

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)

Providers in the same taxonomy and city

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

Competitor

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City CHARLOTTE
Zip Code 28207

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Dataset Information

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.

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