Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 24790 | NC |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 24790 | NC |
NPI | 1245259480 |
---|---|
Provider Name | Darlyne Menscer |
First Address | Charlotte, NC 28260-1372 |
Second Address | Charlotte, NC 28207-1219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1050W | BCBS NC (01) | NC |
1245259480 | (05) | NC |
891050W | (05) | NC |
C81686 | (02) | NC |
N24790 | (05) | SC |