Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 200000529 | NC |
N | 2080A0000X | Adolescent Medicine | 200000529 | NC |
NPI | 1083698005 |
---|---|
Provider Name | Gianna Demos Madrid |
First Address | Charlotte, NC 28260-0447 |
Second Address | Mooresville, NC 28115-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F61516 | (02) |