Basic Information
| Provider Information | |||||||||
| NPI: | 1841397866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULINO | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10111 WHITEBURN CT | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282786638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045275737 | ||||||||
| FaxNumber: | 7049002130 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845514 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 200201144 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | 200201144 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 200201144 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8913256 | 05 | NC | MEDICAID | 802471 | 01 | NC | PARTNERS MEDICARE | OTHER | BP7580512 | 01 | NC | DEA | OTHER | 34D0242865 | 01 | NC | CLIA | OTHER |