Basic Information
| Provider Information | |||||||||
| NPI: | 1922037076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAMMER-PACICCO | ||||||||
| FirstName: | ELAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60099 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045122610 | ||||||||
| FaxNumber: | 7045436773 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 PROVIDENCE RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282262952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045122610 | ||||||||
| FaxNumber: | 7045436773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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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 | 208000000X | 9500598 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2007475 | 01 | NC | AETNA | OTHER | N00598 | 05 | SC | MEDICAID | 64740 | 01 | NC | BCBS | OTHER | 8964740 | 05 | NC | MEDICAID |