| Southpark Functional Medicine Pllc | |
|
5950 Fairview Rd Ste 406 Charlotte NC 28210-3113 | |
| (704) 560-3316 | |
| Not Available |
| Full Name | Southpark Functional Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5950 Fairview Rd Ste 406, Charlotte, North Carolina |
| Authorized Official Name and Position | Sarita Mahtani (PHYSICIAN) |
| Authorized Official Contact | 7045603316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southpark Functional Medicine Pllc 5950 Fairview Rd Ste 406 Charlotte NC 28210-3113 Ph: () - | Southpark Functional Medicine Pllc 5950 Fairview Rd Ste 406 Charlotte NC 28210-3113 Ph: (704) 560-3316 |
| NPI Number | 1275223638 |
|---|---|
| Provider Enumeration Date | 05/10/2023 |
| Last Update Date | 08/02/2023 |
| Medicare PECOS PAC ID | 7810358389 |
|---|---|
| Medicare Enrollment ID | O20230731002742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275223638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sarita Mahtani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891839551 PECOS PAC ID: 3779621107 Enrollment ID: I20230803000613 |
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