Mecklenburg Medical Group

NPI #1710202163 in Matthews, North Carolina

Provider Information

NPI Number: 1710202163
Entity Type: Organization
Organization Name: Mecklenburg Medical Group
Primary Specialty: Internal Medicine
Enumeration Date: Mar 29, 2010
Last Updated: Mar 29, 2010

Practice Location

Address: 332 SAM NEWELL RD
Address 2: SUITE 2000
City: Matthews
State: North Carolina
ZIP Code: 28105-6566
Phone: (704) 302-8500

Authorized Official

Name: DANIEL L WIENS
Title: SENIOR VICE PRESIDENT
Phone: (704) 355-0648

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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