Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 200000756 | NC |
N | 208D00000X | General Practice Physician | 37910 | SC |
NPI | 1033196399 |
---|---|
Provider Name | David Cosenza |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28288-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G26883 | (02) | NC |