Basic Information
| Provider Information | |||||||||
| NPI: | 1093379471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINCHUCK | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | LEONARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 449 N WENDOVER RD STE A | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043166005 | ||||||||
| FaxNumber: | 7043166006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2019 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-09136 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207XX0801X | 0010-09136 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 0010-09136 | 01 | NC | NORTH CAROLINA MEDICAL BOARD | OTHER |