Basic Information
| Provider Information | |||||||||
| NPI: | 1053377630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREMISI | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 MATTHEWS TOWNSHIP PKWY | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281054656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 95-00544 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 19319 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | ME65416 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 9500544 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD15166 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8925593 | 05 | NC | MEDICAID | 25593 | 01 | NC | BCBSNC | OTHER | 561550231G | 01 | NC | CIGNA | OTHER | 276908 | 01 | NC | MAMSI | OTHER | 290003571 | 01 | NC | MEDICARE RAILROAD | OTHER | N00544 | 05 | SC | MEDICAID | 20302 | 01 | NC | PARTNERS | OTHER |