| Fort Health Medical Group Pa | |
|
212 S Tryon St Ste 100 Charlotte NC 28281-0033 | |
| (201) 208-2616 | |
| (973) 381-5773 |
| Full Name | Fort Health Medical Group Pa |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 212 S Tryon St Ste 100, Charlotte, North Carolina |
| Authorized Official Name and Position | Traci Crosby (CREDENTIALING MANAGER) |
| Authorized Official Contact | 2015034815 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Health Medical Group Pa 613 Washington Blvd # 1297 Jersey City NJ 07310-2900 Ph: (201) 208-2616 | Fort Health Medical Group Pa 212 S Tryon St Ste 100 Charlotte NC 28281-0033 Ph: (201) 208-2616 |
| NPI Number | 1114766284 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Certification Date | 05/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114766284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
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