Active NPI
Tina Petok, M.D.
- Gynecology Physician
- Charlotte, NC
National Provider Identifier
1861464810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 32417
- Practice address
- 8220 University Exec Park Dr
Suite 107
Charlotte, NC 28262-3380 - Phone
- (704) 548-1221
- Fax
- (704) 548-1311
- NPI assigned
- Feb 3, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 32417 | NC | Primary |
Addresses
Primary practice location
8220 University Exec Park Dr
Suite 107
Charlotte, NC 28262-3380
Mailing address
8220 University Exec Park Dr
Ste 107
Charlotte, NC 28262-3380
Phone (704) 548-1221
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8967234 | Medicaid | NC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191283200000",
"number": "1861464810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8220 UNIVERSITY EXEC PARK DR",
"address_2": "STE 107",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282623380",
"telephone_number": "704-548-1221",
"fax_number": "704-548-1311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 UNIVERSITY EXEC PARK DR",
"address_2": "SUITE 107",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282623380",
"telephone_number": "704-548-1221",
"fax_number": "704-548-1311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETOK",
"first_name": "TINA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-03",
"last_updated": "2007-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NC",
"license": "32417",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8967234",
"state": "NC"
}
],
"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 Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.