Provider Demographics
NPI:1649299488
Name:MABRY, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MABRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-667-4150
Mailing Address - Fax:704-752-7040
Practice Address - Street 1:6404 CARMEL RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8278
Practice Address - Country:US
Practice Address - Phone:704-650-2348
Practice Address - Fax:704-752-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-00098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00098Medicaid
NY110221536OtherMEDICARE RAILROAD
NC891113MMedicaid
NC1113MOtherBCBS
NC1649299488Medicaid
NY110221536OtherMEDICARE RAILROAD
NC1649299488Medicaid
NC225353YAMedicare PIN