Provider Demographics
NPI:1396756722
Name:COLAVITA, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:COLAVITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLYTHE BLVD
Mailing Address - Street 2:SUITE 300 - ADULT CARDIOLOGY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 300 - ADULT CARDIOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14437207RC0000X, 207RC0000X
NC26215207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396756722Medicaid
SCN26215Medicaid
NC23549OtherBCBS
NC8923549Medicaid
P00205131OtherRAILROAD MEDICARE
NC23549OtherBCBS
NC1396756722Medicaid
NC8923549Medicaid
NC205506QMedicare PIN