Provider Demographics
NPI:1528056314
Name:TROMBLEY, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1075
Mailing Address - Country:US
Mailing Address - Phone:704-334-6488
Mailing Address - Fax:704-334-6486
Practice Address - Street 1:300 BILLINGSLEY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1075
Practice Address - Country:US
Practice Address - Phone:704-334-6488
Practice Address - Fax:704-334-6486
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC94-00162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989778Medicaid
NCF74197Medicare UPIN