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Contact Information

JONATHAN L LAKE, PAC
225 BALDWIN AVE
CHARLOTTE, NC28204-3109
 Phone: 704-376-1605
 Fax: 704-335-8448
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JONATHAN L LAKE · (Male)

NPI Number 1346283801
Status Active
Credentials PAC
Entity Individual
Enumeration date 06/13/2006
Last updated 08/06/2025 - About 10 months ago
Sole proprietor 1 No
Identifiers
  • NC License # 103630
  • Other P00344444 RAILROAD MEDICARE
Hospital affiliation(s)
  • CAROLINAS MEDICAL CENTER/BEHAV HEALTH - (Acute Care)
    1000 BLYTHE BLVD
    CHARLOTTE, NC 28203
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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