Basic Information
Provider Information
NPI: 1225098387
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMOS
FirstName: ARLENE
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 751803
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282751803
CountryCode: US
TelephoneNumber: 3364757163
FaxNumber: 3364751199
Practice Location
Address1: 903 RANDOLPH ST
Address2: SUITE 1
City: THOMASVILLE
State: NC
PostalCode: 273605898
CountryCode: US
TelephoneNumber: 3364757163
FaxNumber: 3364751199
Other Information
ProviderEnumerationDate: 03/24/2006
LastUpdateDate: 10/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X9901297NCY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
891218Q05NC MEDICAID


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