Provider Demographics
NPI:1215297106
Name:HILGENFELDT, ERIC GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GLENN
Last Name:HILGENFELDT
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 1:5960 FAIRVIEW RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3102
Mailing Address - Country:US
Mailing Address - Phone:704-634-6324
Mailing Address - Fax:844-624-2406
Practice Address - Street 1:16817 MARVIN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2196
Practice Address - Country:US
Practice Address - Phone:704-495-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125676207R00000X
FLTRN17323207R00000X
NC2018-02743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215297106Medicaid
FL015831500Medicaid