| Cotswold Family Medicine | |
|
309 S Sharon Amity Rd Ste 100 Charlotte NC 28211-2978 | |
| (704) 446-2360 | |
| Not Available |
| Full Name | Cotswold Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 309 S Sharon Amity Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Scott Rissmiller (ENTERPRISE EVP) |
| Authorized Official Contact | 7043558675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cotswold Family Medicine Po Box 19305 Charlotte NC 28219-9305 Ph: (704) 631-0002 | Cotswold Family Medicine 309 S Sharon Amity Rd Ste 100 Charlotte NC 28211-2978 Ph: (704) 446-2360 |
| NPI Number | 1083642169 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 03/09/2023 |
| Medicare PECOS PAC ID | 7911978218 |
|---|---|
| Medicare Enrollment ID | O20040802000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083642169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Susan M Stephen Lester |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073513388 PECOS PAC ID: 5799759825 Enrollment ID: I20050822000188 |
| Provider Name | Daniel L Rosenberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427151851 PECOS PAC ID: 4688676612 Enrollment ID: I20070205000349 |
| Provider Name | Jessica P Ignash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720497571 PECOS PAC ID: 4284855925 Enrollment ID: I20141022002589 |
| Provider Name | Emily Haynes Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679602957 PECOS PAC ID: 3870647621 Enrollment ID: I20150114002517 |
| Provider Name | Joann Tao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972920809 PECOS PAC ID: 3274755970 Enrollment ID: I20171114001680 |
| Provider Name | Phiyen Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962994558 PECOS PAC ID: 1759630213 Enrollment ID: I20180817000089 |
| Provider Name | Matthew James Poplin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407352727 PECOS PAC ID: 0840548319 Enrollment ID: I20210730001528 |
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