Provider Demographics
NPI:1396935771
Name:LARBI-SIAW, KWAME
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:LARBI-SIAW
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 1:1000 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:CMC ANNEX 1ST FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01297207R00000X
IN01067192A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396935771Medicaid
SCNC1609Medicaid
IN000000722199OtherANTHEM TRADITIONAL
IN200963230Medicaid
NC1396935771Medicaid
NCNC7159CMedicare PIN
NCNC7159A293Medicare PIN
NCNC7159BMedicare PIN
NCNC7159FMedicare PIN
SCNC1609Medicaid
INM400049671Medicare PIN
IN000000722199OtherANTHEM TRADITIONAL
NCNC7159AMedicare PIN