Active NPI
Siddharth Dalal, MD
- Neurology Physician
- Charlotte, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 2024-01310
- Practice address
- 200 Hawthorne LN
Charlotte, NC 28204-2515 - Phone
- (704) 384-9437
- NPI assigned
- May 18, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 12
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 101754 | GA | |
| Neurology Physician | 2084N0400X | 0101282560 | VA | |
| Neurology Physician | 2084N0400X | 2024032609 | MO | |
| Neurology Physician | 2084N0400X | 341425 | LA | |
| Neurology Physician | 2084N0400X | 2024-01310 | NC | Primary |
| Neurology Physician | 2084N0400X | ME169008 | FL | |
| Neurology Physician | 2084N0400X | MD61554733 | WA | |
| Neurology Physician | 2084N0400X | 036.171540 | IL | |
| Neurology Physician | 2084N0400X | 84723-20 | WI | |
| Neurology Physician | 2084N0400X | 71288 | TN | |
| Neurology Physician | 2084N0400X | 326381 | NY | |
| Neurology Physician | 2084N0400X | MD220760 | OR |
Addresses
Primary practice location
200 Hawthorne LN
Charlotte, NC 28204-2515
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other practice location 1
2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200
Other practice location 2
2211 NE 139th St
Vancouver, WA 98686-2742
Phone (360) 487-1000
Other practice location 3
1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000
Other practice location 4
300 Community Dr
Manhasset, NY 11030-3816
Phone (516) 325-7000
Other practice location 5
2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000
Other practice location 6
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-3150
Other practice location 7
1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111
Other practice location 8
300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000
Other practice location 9
100 15th St NW
Norton, VA 24273-1616
Phone (423) 630-7001
Other practice location 10
1102 W 32nd St
Joplin, MO 64804-3503
Phone (417) 347-4570
Other practice location 11
1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 851-8000
Other practice location 12
3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000
Other practice location 13
127 Health Care Dr
Pennington Gap, VA 24277-2853
Phone (276) 299-5000
Other practice location 14
12200 Warwick Blvd Ste 110
Newport News, VA 23601-2344
Phone (757) 534-5100
Other practice location 15
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121
Other practice location 16
400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111
Other practice location 17
851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000
Other practice location 18
1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300
Other practice location 19
1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5000
Other practice location 20
375 N Wall St Ste P510
Kankakee, IL 60901-3492
Phone (815) 935-0750
Other practice location 21
2030 Temple Hill Rd
Erwin, TN 37650-8721
Phone (423) 743-3141
Other practice location 22
1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1100
Other practice location 23
16000 Johnston Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-1000
Other practice location 24
245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000
Other practice location 25
58 Carroll Street
Lebanon, VA 24266-4510
Phone (276) 883-8000
Other practice location 26
312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, VA, NC, TN, MO, WA, GA, MS, ME, OR, IL, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 12
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240429000558 | NY | Practitioner - Neurology | 4789928730 | Reassigns benefits to 6 organizations |
| I20240805004201 | VA | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20240919001809 | NC | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20241125000381 | TN | Practitioner - Neurology | 4789928730 | Reassigns benefits to 1 organization |
| I20250115003480 | MO | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20250415003403 | WA | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20250519000770 | GA | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20250715004204 | MS | Practitioner - Neurology | 4789928730 | Reassigns benefits to 1 organization |
| I20250808000306 | ME | Practitioner - Neurology | 4789928730 | Reassigns benefits to 5 organizations |
| I20250910002608 | OR | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
| I20260127002075 | IL | Practitioner - Neurology | 4789928730 | Reassigns benefits to 1 organization |
| I20260129002483 | WI | Practitioner - Neurology | 4789928730 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Atlanta Professional Services LLCNorth Shore-Lij Medical PCAdventist Health System Georgia IncFreeman-Oak Hill Health SystemRiverside Physician Services IncWellmont Medical Associates IncNorth Oaks Medical Center LLCWakemedSinging River Health SystemManhattan Medical Arts PLLC
Practice addresses (Care Compare)
1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 851-8000
10201 66TH Rd
Forest Hills, NY 11375-2029
Phone (718) 830-4000
1035 Red Bud Rd NE
Suite 101
Calhoun, GA 30701-6011
Phone (706) 625-4285
1102 W 32 St
Joplin, MO 64804-3503
12200 Warwick Blvd
Suite 110
Newport News, VA 23601-2344
Phone (757) 534-5100
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 230-8412
16000 Johnson Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-8200
189 Schermerhorn St
Apt 21C
Brooklyn, NY 11201-6614
Phone (478) 284-3074
3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000
3603 Bienville Blvd
Ocean Springs, MS 39564-5727
Phone (228) 818-9620
492 6TH Ave
New York, NY 10011-8404
Phone (646) 454-9000
Hospital & facility affiliations
- Staten Island University Hospital
- North Shore University Hospital
- Freeman Health System - Freeman West
- Peconic Bay Medical Center
- Northside Hospital Gwinnett
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.91 of 100
- Quality
- 78.17
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 67.71
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 79.77
- Promoting interoperability
- 88.77
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.91 of 100
- Quality
- 92.86
- Promoting interoperability
- 94.93
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 326381 | NY | MD | Licensed Practical Nurse |
| ME169008 | FL | MD | Neurology Physician |
| 036.171540 | IL | MD | Neurology Physician |
| 341425 | LA | MD | Neurology Physician |
| 2024032609 | MO | MD | Neurology Physician |
| 2024-01310 | NC | MD | Neurology Physician |
| 71288 | TN | MD | Neurology Physician |
Practice roles (53 of 57)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centra Medical Group, LLC | Current | Accepting new patients | |
| Wellmont Medical Associates, Inc. | Current | Accepting new patients | |
| Riverside Health System | Current | Accepting new patients | |
| Bridgton Hospital | Current | Accepting new patients | |
| Riverside Physician Services, Inc. | Internal Medicine | Current | Accepting new patients |
| Wellmont Medical Associates Inc | Current | Accepting new patients | |
| Wellmont Medical Associates Inc | Internal Medicine | Current | Accepting new patients |
| Singing River Health System | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients | |
| Wyoming County | Current | Accepting new patients | |
| Rumford Hospital | Current | Accepting new patients | |
| Legacy Salmon Creek Hospital | Current | Accepting new patients | |
| Wakemed | Internal Medicine | Current | Accepting new patients |
| North Oaks Medical Center, LLC | Current | Accepting new patients | |
| Riverside Physician Services Inc | Current | Accepting new patients | |
| Wellmont Medical Associates, Inc. | Internal Medicine | Current | Accepting new patients |
| Central Maine Medical Center | Current | Accepting new patients | |
| Vidant Medical Group LLC | Current | Accepting new patients | |
| Manhattan Medical Arts, PLLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Riverside Health System | Current | Accepting new patients | |
| Freeman-Oak Hill Health System | Internal Medicine | Current | Accepting new patients |
| Bridgton Hospital | Current | Accepting new patients | |
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Wyoming County | Internal Medicine | Current | Accepting new patients |
| Legacy Salmon Creek Hospital | Current | Accepting new patients | |
| North Oaks Medical Center, LLC | Current | Accepting new patients | |
| Legacy Clinics LLC | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients | |
| Riverside Physician Services Inc | Current | Accepting new patients | |
| North Shore-Lij Medical PC | Internal Medicine | Current | Accepting new patients |
| North Shore - Lij Medical PC | Internal Medicine | Current | Accepting new patients |
| The Monroe Clinic, Inc. | Current | Accepting new patients | |
| The Monroe Clinic, Inc. | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Wyoming County | Current | Accepting new patients | |
| Adventist Health System Georgia Inc | Current | Accepting new patients | |
| Rumford Hospital | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Legacy Clinics LLC | Internal Medicine | Current | Accepting new patients |
| Agnesian Healthcare Inc | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Neurology | Current | Accepting new patients |
| North Atlanta Professional Services LLC | Current | Accepting new patients | |
| Central Maine Medical Center | Current | Accepting new patients | |
| Freeman-Oak Hill Health System | Current | Accepting new patients | |
| Wakemed | Current | Accepting new patients | |
| Wyoming County | Current | Accepting new patients | |
| Montefiore New Rochelle Hospital | Past | Accepting new patients | |
| Staten Island University Hospital | Past | Accepting new patients | |
| Adventist Health System Georgia, Inc. | Past | Accepting new patients |
Locations (25 of 61)
1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800
1035 Red Bud Rd NE
Ste 101
Calhoun, GA 30701
Phone (706) 625-4285
707 Old Dalton Ellijay Rd
Chatsworth, GA 30705
Phone (706) 517-2050
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000
1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737
375 N Wall St
Ste P510
Kankakee, IL 60901
Phone (815) 935-0750
105 S First St
Wilmington, IL 60481
Phone (815) 476-5210
15790 Paul Vega Md Dr
Hammond, LA 70403
Phone (985) 230-1682
10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000
300 Main St
Lewiston, ME 04240
Phone (207) 795-2400
420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581
1102 W 32nd St
Joplin, MO 64804
Phone (417) 347-1078
307 W 11th St
Lamar, MO 64759
Phone (417) 682-3300
2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576
3603 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 762-3000
1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300
1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437
200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424
3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000
5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441
190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200
2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300
10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091
7214 Austin St
Forest Hills, NY 11375
Phone (646) 454-9000
492 6th Ave
New York, NY 10011
Phone (646) 454-9000
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
Interoperability endpoints
- sdalal1602803@direct.novanthealth.org
- https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/
- sdalal66984@northwell.direct-ci.com
Organizations & group practices 85
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.
-
- Multi-Specialty Clinic/Center
- Joplin, MO
- NPI 1679517023
Internal Medicine, MO
-
- Adolescent Medicine (Family Medicine) Physician
- New York, NY
- NPI 1396211918
NY
-
- Pulmonary Disease Physician
- Kingsport, TN
- NPI 1780986257
Internal Medicine, TN
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Webb City, MO
- NPI 1114394228
Hospital
-
- General Acute Care Hospital
- Staten Island, NY
- NPI 1407877137
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787875200000",
"number": "1811488455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWTHORNE LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042515",
"telephone_number": "704-384-9437"
}
],
"practiceLocations": [
{
"address_1": "2801 N Gantenbein Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972271623",
"country_code": "US",
"telephone_number": "503-413-2200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2211 NE 139th St",
"address_purpose": "LOCATION",
"city": "Vancouver",
"state": "WA",
"postal_code": "986862742",
"country_code": "US",
"telephone_number": "360-487-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1420 Tusculum Blvd",
"address_purpose": "LOCATION",
"city": "Greeneville",
"state": "TN",
"postal_code": "377454279",
"country_code": "US",
"telephone_number": "423-787-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Community Dr",
"address_purpose": "LOCATION",
"city": "Manhasset",
"state": "NY",
"postal_code": "110303816",
"country_code": "US",
"telephone_number": "516-325-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2000 Brookside Dr",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376604627",
"country_code": "US",
"telephone_number": "423-857-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 W Ravine Rd",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376603837",
"country_code": "US",
"telephone_number": "423-224-3150",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1990 Holton Ave E",
"address_purpose": "LOCATION",
"city": "Big Stone Gap",
"state": "VA",
"postal_code": "242193350",
"country_code": "US",
"telephone_number": "276-523-3111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Med Tech Pkwy",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376042277",
"country_code": "US",
"telephone_number": "423-302-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 15th St NW",
"address_purpose": "LOCATION",
"city": "Norton",
"state": "VA",
"postal_code": "242731616",
"country_code": "US",
"telephone_number": "423-630-7001",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1102 W 32nd St",
"address_purpose": "LOCATION",
"city": "Joplin",
"state": "MO",
"postal_code": "648043503",
"country_code": "US",
"telephone_number": "417-347-4570",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1000 Johnson Ferry Rd",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303421606",
"country_code": "US",
"telephone_number": "404-851-8000",
"fax_number": "404-303-3759",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3000 New Bern Ave",
"address_purpose": "LOCATION",
"city": "Raleigh",
"state": "NC",
"postal_code": "276101231",
"country_code": "US",
"telephone_number": "919-350-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "127 Health Care Dr",
"address_purpose": "LOCATION",
"city": "Pennington Gap",
"state": "VA",
"postal_code": "242772853",
"country_code": "US",
"telephone_number": "276-299-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12200 Warwick Blvd Ste 110",
"address_purpose": "LOCATION",
"city": "Newport News",
"state": "VA",
"postal_code": "236012344",
"country_code": "US",
"telephone_number": "757-534-5100",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Medical Park Blvd",
"address_purpose": "LOCATION",
"city": "Bristol",
"state": "TN",
"postal_code": "376207430",
"country_code": "US",
"telephone_number": "423-844-1121",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "400 N State Of Franklin Rd",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376046035",
"country_code": "US",
"telephone_number": "423-431-6111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "851 Locust St",
"address_purpose": "LOCATION",
"city": "Rogersville",
"state": "TN",
"postal_code": "378572407",
"country_code": "US",
"telephone_number": "423-921-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1501 W Elk Ave",
"address_purpose": "LOCATION",
"city": "Elizabethton",
"state": "TN",
"postal_code": "376432874",
"country_code": "US",
"telephone_number": "423-542-1300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1519 Main St",
"address_purpose": "LOCATION",
"city": "Sneedville",
"state": "TN",
"postal_code": "378693657",
"country_code": "US",
"telephone_number": "423-733-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "375 N Wall St Ste P510",
"address_purpose": "LOCATION",
"city": "Kankakee",
"state": "IL",
"postal_code": "609013492",
"country_code": "US",
"telephone_number": "815-935-0750",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2030 Temple Hill Rd",
"address_purpose": "LOCATION",
"city": "Erwin",
"state": "TN",
"postal_code": "376508721",
"country_code": "US",
"telephone_number": "423-743-3141",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1901 S Shady St",
"address_purpose": "LOCATION",
"city": "Mountain City",
"state": "TN",
"postal_code": "376832021",
"country_code": "US",
"telephone_number": "423-727-1100",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16000 Johnston Memorial Dr",
"address_purpose": "LOCATION",
"city": "Abingdon",
"state": "VA",
"postal_code": "242117664",
"country_code": "US",
"telephone_number": "276-258-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "245 Medical Park Dr",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "VA",
"postal_code": "243541100",
"country_code": "US",
"telephone_number": "276-378-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "58 Carroll Street",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "VA",
"postal_code": "242664510",
"country_code": "US",
"telephone_number": "276-883-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "312 Hospital Dr",
"address_purpose": "LOCATION",
"city": "Clintwood",
"state": "VA",
"postal_code": "242286786",
"country_code": "US",
"telephone_number": "276-926-0300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DALAL",
"first_name": "SIDDHARTH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-18",
"last_updated": "2026-08-28",
"certification_date": "2026-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "GA",
"license": "101754",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "VA",
"license": "0101282560",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MO",
"license": "2024032609",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "LA",
"license": "341425",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NC",
"license": "2024-01310",
"primary": true
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "FL",
"license": "ME169008",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WA",
"license": "MD61554733",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IL",
"license": "036.171540",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WI",
"license": "84723-20",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TN",
"license": "71288",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "326381",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "OR",
"license": "MD220760",
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}
],
"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 Aug 28, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.