Manuel F Maldonado, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103143 Issued in NC

Practice address

445 S Kings Dr
Charlotte, NC 28204-3041

Phone

(980) 308-0141

Fax

(980) 308-0140

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmaldonado15479@direct.novanthealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Medicorp Enterprises, LLC

  dba Novant Health GoHealth Urgent Care

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment NPD
• Carolina Medicorp Enterprises, LLC

  dba Novant Health GoHealth Urgent Care

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD
• Carolina Medicorp Enterprises Inc

  dba Novant Health Pediatric Urgent Care

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1417497504
  NPD (past)
• Metrolina AIDS Project, Inc.

  dba Metrolina Care Network

  • Health Service Clinic/Center
  • Charlotte, NC
  • NPI 1164675914
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1144274960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601843",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043041",
            "telephone_number": "980-308-0141",
            "fax_number": "980-308-0140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11840 Southmore Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774821",
            "country_code": "US",
            "telephone_number": "980-308-0169",
            "fax_number": "980-308-0173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13129 S Tryon St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282787915",
            "country_code": "US",
            "telephone_number": "980-337-4662",
            "fax_number": "980-337-4658",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "MANUEL",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101503",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmaldonado15479@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "445 S Kings Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Timothy Malaney, M.D.
• Christopher Joseph Malara
• Liza Maldari, PH.D.
• Maldo, LLC (Executive Care)
• Ashleigh Michelle Maldonado
• Lisa B Malec, OTR
• Colleen Mary Malecki, OTR/L
• Scott A Malesiewski, PT
• Kaaya Malhotra, D.O.
• Pooja Malhotra, MD

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.