Basic Information
| Provider Information | |||||||||
| NPI: | 1235102187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABAQUETA | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 MEDICAL PLAZA DR | ||||||||
| Address2: | STE 365 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282628797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049440975 | ||||||||
| FaxNumber: | 7049433699 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 MEDICAL PLAZA DR | ||||||||
| Address2: | STE 365 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282628797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049440975 | ||||||||
| FaxNumber: | 7049433699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 98-00751 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | N00751 | 05 | SC | MEDICAID | 8911654 | 05 | NC | MEDICAID |