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? 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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