| Medical Plaza Family & Geriatric Physicians, Pa | |
|
8401 Medical Plaza Dr Suite 365 Charlotte NC 28262-8797 | |
| (704) 944-0975 | |
| (704) 943-0699 |
| Full Name | Medical Plaza Family & Geriatric Physicians, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 8401 Medical Plaza Dr, Charlotte, North Carolina |
| Authorized Official Name and Position | William J Long (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7049440975 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Plaza Family & Geriatric Physicians, Pa 8401 Medical Plaza Dr Suite 365 Charlotte NC 28262-8797 Ph: (704) 944-0975 | Medical Plaza Family & Geriatric Physicians, Pa 8401 Medical Plaza Dr Suite 365 Charlotte NC 28262-8797 Ph: (704) 944-0975 |
| NPI Number | 1851630172 |
|---|---|
| Provider Enumeration Date | 02/06/2013 |
| Last Update Date | 04/27/2023 |
| Medicare PECOS PAC ID | 4385885706 |
|---|---|
| Medicare Enrollment ID | O20130729000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851630172 | NPI | - | NPPES |
| 5922886 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 189833 (North Carolina) | Primary |
| Provider Name | William J Long |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992778906 PECOS PAC ID: 5698813798 Enrollment ID: I20091110000668 |
| Provider Name | Alvin Abaqueta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235102187 PECOS PAC ID: 8628105277 Enrollment ID: I20100429001195 |
| Provider Name | Amy Hendricks Palacios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851874200 PECOS PAC ID: 1052655073 Enrollment ID: I20181203001523 |
| Provider Name | Tilia Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942897095 PECOS PAC ID: 2365855723 Enrollment ID: I20210105000800 |
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