Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2009-00994 | NC |
N | 2086S0120X | Pediatric Surgery | E-5149 | AR |
NPI | 1275741076 |
---|---|
Provider Name | Graham Harvey Cosper |
First Address | Charlotte, NC 28207-1106 |
Second Address | Charlotte, NC 28207-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 29/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2075144 | MEDICARE (01) | |
5912425 | MEDICAID (01) | NC |
N94009 | MEDICAID (01) | SC |