Basic Information
| Provider Information | |||||||||
| NPI: | 1194793745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTHER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | SUSAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | 9600160 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 269145 | 01 | NC | WELLPATH | OTHER | E0574 | 01 | NC | MEDCOST | OTHER | P00202361 | 01 | NC | RAILROAD MEDICARE | OTHER | 81894 | 01 | SC | CHC CARES OF SC | OTHER | 20097007 | 01 | SC | SELECT HEALTH OF SC | OTHER | N00160 | 05 | SC | MEDICAID | 30774 | 01 | NC | BCBS | OTHER | 4469887 | 01 | NC | AETNA | OTHER | 771257 | 01 | SC | WELLCARE | OTHER | 8930774 | 05 | NC | MEDICAID | 000000291357 | 01 | SC | UNISON HEALTH PLAN OF SC | OTHER |