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  • North Carolina Medical Board Name Change Form - Nc Medical Board - Ncmedboard

Get North Carolina Medical Board Name Change Form - Nc Medical Board - Ncmedboard

? NORTH?CAROLINA?MEDICAL?BOARD? NAME?CHANGE?FORM? ? You?may?email,?mail?or?fax?this?form?to?the?North?Carolina?Medical?Board.?Please?attach?one? copy?of?the?legal?documentation?(marriage?certificate,?divorce?paper?decree,?etc.).? ? The?documentation?that?you?submit?does?not?need?to?be?certified.? ? Complete?and?mail?or?fax?this?form?to?the?Board?s?office.? ? EMAIL,?MAIL?OR?FAX?THIS?FORM?TO:? Email:?registration ncmedboard.org????????????? Fax:?????(919)?326.

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Related content

North Carolina Medical Board Anticipated Rule...
At the current time, the NC Medical Board anticipates the following rule activity in 2019...
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Carolina Medical Board has enacted several initiatives to decrease unsafe ... comments...
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Contact support

Call Us Toll-free number: (800) 253.9653. Telephone: (919) 326.1100 or (919) 326.1109. Fax: (919) 326-1131.

Please contact the Board's Complaint Department at 1-800-253-9653 (ext. 501).

Your license to practice medicine in the State of North Carolina doesn't come without additional costs. As a brand new licensee, extra charges include: A $400 application fee.

Click on the Address Change form at right to log in to your Licensee Information Page. Select “Address” to update your home or practice address. Anesthesiologist assistants, clinical pharmacist practitioners and licensed perfusionists must submit paper address change forms at this time.

The online Intent to Practice (ITP) form is used to add a supervisor, change a supervisor and remove a supervisor. PAs are required to submit the ITP form before they may lawfully begin performing medical acts in NC. PAs are required to submit a new ITP form each time they add or change a primary supervising physician.

The first step is for you to submit the application online and pay for it. The second step is for all supporting documentation be received by NCMB, including the results of the criminal background check. You should expect the process to take approximately four months.

The Board's primary mission is to protect the public. It screens candidates for licensure, issues licenses to qualified professionals, develops rules and positions that guide its licensees and, when necessary, disciplines its licensees.

If you have questions or concerns about your renewal, you may contact the Board's registration coordinator by email or telephone at (800) 253-9653, extension 387.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232