Active NPI
Benjamin Fonseca
- Athletic Trainer
- Charlotte, NC
National Provider Identifier
1124459862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1814
- Practice address
- 10318 Glenburn LN
Charlotte, NC 28278-6005 - Phone
- (704) 906-8095
- NPI assigned
- Dec 5, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1814 | NC | Primary |
Addresses
Primary practice location
10318 Glenburn LN
Charlotte, NC 28278-6005
Mailing address
10318 Glenburn LN
Charlotte, NC 28278-6005
Phone (704) 906-8095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1814 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386201600000",
"number": "1124459862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10318 GLENBURN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282786005",
"telephone_number": "704-906-8095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10318 GLENBURN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282786005",
"telephone_number": "704-906-8095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONSECA",
"first_name": "BENJAMIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-05",
"last_updated": "2013-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "1814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.