Provider Demographics
NPI:1902898679
Name:CALHOUN, AUBREY
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PROFESSIONAL PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6541
Mailing Address - Country:US
Mailing Address - Phone:704-660-2634
Mailing Address - Fax:
Practice Address - Street 1:137 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6540
Practice Address - Country:US
Practice Address - Phone:704-663-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11802207R00000X
NC30136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902898679Medicaid
NC8920774Medicaid
SCNC2442Medicaid
NC205263HMedicare PIN
NC205263CMedicare PIN
NC203739FMedicare PIN
NC8920774Medicaid
NC205263MMedicare PIN
NC203739JMedicare PIN
NCNC1886AMedicare PIN
NCNC1886A293Medicare PIN
NC203739LMedicare PIN
NC205263UMedicare PIN
NCNC1886A229Medicare PIN
NCNC1886BMedicare PIN
SCNC2442Medicaid
NC1902898679Medicaid
NCNC1886A459Medicare PIN
NCC82047Medicare UPIN
NC205263SMedicare PIN
NC205263VMedicare PIN