Provider Demographics
NPI:1053382804
Name:DEAN, DONNA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:DEAN
Suffix:
Gender:F
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:SUITE 255
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800235208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11436OtherBCBSNC
NC200867OtherMEDCOST
NC2166066OtherMAMSI
NC0095686OtherCIGNA
SCN00235Medicaid
NC1053382804Medicaid
NC26313OtherPARTNERS MEDICARE CHOICE
NC8911436Medicaid
NC11436OtherBCBS
NC2166066OtherMAMSI
NC1053382804Medicaid
NCNCB427AMedicare PIN
NC11436OtherBCBS
NC11436OtherBCBSNC