Basic Information
| Provider Information | |||||||||
| NPI: | 1477537553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERNEST | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MCDONALD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601372 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043553153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 BLYTHE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043553153 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 12/03/2010 | ||||||||
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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 | 207V00000X | 25133 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 25133 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 23490 | 01 | MEDCOST | OTHER | 4098422 | 01 | AETNA | OTHER | 6227457 | 05 | VA | MEDICAID | 8930759 | 05 | NC | MEDICAID | 1810925000 | 05 | WV | MEDICAID | 30759 | 01 | BCBS | OTHER | 408 | 01 | PARTNERS | OTHER | Q25133 | 05 | SC | MEDICAID |