Provider Demographics
NPI:1285610956
Name:CHARLOTTE TRAUMA SERVICES, PLLC
Entity type:Organization
Organization Name:CHARLOTTE TRAUMA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGESTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:704-998-2162
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-364-8100
Practice Address - Fax:704-365-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC864202086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790298JMedicaid
NC2344336Medicare ID - Type UnspecifiedCTS MEDICARE GROUP NUMBER