Provider Demographics
NPI:1295137941
Name:MCGIVERON, AMANDA EILEEN (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:MCGIVERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-874-0201
Practice Address - Street 1:2325 W ARBORS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2664
Practice Address - Country:US
Practice Address - Phone:704-295-3500
Practice Address - Fax:704-295-3506
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2882PAMedicaid
NCP01911432OtherRAILROAD MEDICARE