Provider Demographics
NPI:1851669998
Name:BAUGUESS, MEREDITH B (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:B
Last Name:BAUGUESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 NE GATEWAY CT NE
Practice Address - Street 2:STE 290
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-403-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851669998Medicaid
NCNCG492BMedicare PIN
NCNCG492DMedicare PIN
NCNCG492EMedicare PIN
NC1851669998Medicaid
NCNCG492AMedicare PIN