Provider Demographics
NPI:1053377630
Name:CREMISI, HENRY D (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
Last Name:CREMISI
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5416
Mailing Address - Fax:704-384-5992
Practice Address - Street 1:1500 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4656
Practice Address - Country:US
Practice Address - Phone:704-384-5416
Practice Address - Fax:704-384-5992
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-00544207RN0300X
SC19319207RN0300X
FLME65416207RN0300X
NC9500544207R00000X
RIMD15166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925593Medicaid
NC25593OtherBCBSNC
NC561550231GOtherCIGNA
NC276908OtherMAMSI
NC290003571OtherMEDICARE RAILROAD
SCN00544Medicaid
NC20302OtherPARTNERS
NC2211734Medicare PIN
NC276908OtherMAMSI
NC8925593Medicaid