Provider Demographics
NPI:1639123391
Name:HEART CARE CENTER OF CHARLOTTE
Entity type:Organization
Organization Name:HEART CARE CENTER OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARAHANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-364-0057
Mailing Address - Street 1:3626 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1388
Mailing Address - Country:US
Mailing Address - Phone:704-364-0057
Mailing Address - Fax:704-644-1290
Practice Address - Street 1:3626 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1388
Practice Address - Country:US
Practice Address - Phone:704-364-0057
Practice Address - Fax:704-362-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBC/BSOther012HC
NC89012HCMedicaid
SCNPA871Medicaid
NCBC/BSOther012HC