| Patina Medical Group, Pc | |
|
101 N Tryon St Ste 600 Charlotte NC 28246-0100 | |
| (855) 478-8208 | |
| Not Available |
| Full Name | Patina Medical Group, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 N Tryon St Ste 600, Charlotte, North Carolina |
| Authorized Official Name and Position | Neil Patel (CHIEF HEALTH OFFICER) |
| Authorized Official Contact | 8554788208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patina Medical Group, Pc 150 Monument Rd Ste 500 Bala Cynwyd PA 19004-1701 Ph: (855) 478-8208 | Patina Medical Group, Pc 101 N Tryon St Ste 600 Charlotte NC 28246-0100 Ph: (855) 478-8208 |
| NPI Number | 1467147710 |
|---|---|
| Provider Enumeration Date | 04/11/2023 |
| Last Update Date | 04/11/2023 |
| Medicare PECOS PAC ID | 4688038854 |
|---|---|
| Medicare Enrollment ID | O20230907000951 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467147710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Neil Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700085271 PECOS PAC ID: 6406915545 Enrollment ID: I20191121001144 |
| Provider Name | Kathryn Maceyko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760856736 PECOS PAC ID: 1658728993 Enrollment ID: I20240322002172 |
| Provider Name | Michelle Lu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750856803 PECOS PAC ID: 9133559669 Enrollment ID: I20240329002044 |
| Provider Name | Alexandra Ristow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114361839 PECOS PAC ID: 7113210105 Enrollment ID: I20240408001861 |
| Provider Name | Jamie Sikora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801294954 PECOS PAC ID: 6901117308 Enrollment ID: I20240410000395 |
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