Interstate Medical Licensure Compact (IMLC)

The IMLC licensure pathway was implement in in North Carolina in January 2026.

No. The IMLC does not automatically grant you authority to practice in other states. The IMLC is an expedited pathway to licensure in all participating Compact member states. You are still required to apply for licenses in other states, which you may do if you are eligible by applying through the IMLC Commission website.

Generally, you are required to hold a license in any state where your patient is located at the time of care.

No. The IMLC is a streamlined process for obtaining licenses in other Compact states and participation is completely voluntary.

Please visit the IMLC Commission website for a map of current participating states.

A Letter of Qualification (LOQ) is issued by the state in which you currently hold a medical license and states that you are eligible to apply for licensure with any Compact member state. North Carolina licensed physicians wanting to use North Carolina as their SPL to apply to other Compact member states will need to request a LOQ from North Carolina. An LOQ is valid for 365 days from the date of issuance.

A Letter of Qualification (LOQ) issued by the physician’s state of principal license is valid for 365 days from the date of issuance.

An SPL is the Compact member state where a physician holds a full and unrestricted medical license. If you hold a full and unrestricted medical license in North Carolina, North Carolina may serve as your SPL as long as you meet at least one of the following:

• The physician’s primary residence is in North Carolina
• At least 25% of the physician’s practice of medicine occurs in North Carolina
• The physician’s employer is located in North Carolina
• North Carolina is the physician’s state of residence for U.S. Federal income tax purposes

• You must go to the IMLC Commission website, confirm you are eligible, and start the application process for a Letter of Qualification (LOQ) by selecting apply. During the application process, you will select North Carolina as your SPL, complete the application form, and pay the non-refundable $700 fee.
• The IMLC Commission will forward your LOQ request to NCMB, which will send you instructions on how to submit your fingerprints for a national criminal background check as well as the additional documentation that is required to verify North Carolina as your state of principal licensure. You will be required to remit $38 to NCMB to cover the cost of the criminal background check. You must complete the fingerprinting process within 60 days of submitting your request or your application will expire.
 
• NCMB will review your application, including your criminal background check and SPL documentation, to verify your eligibility. If you qualify, you will be an issued an LOQ.
• Once you receive your LOQ, you will go to the IMLC Commission website to begin the process of applying for licenses in other states, which will include paying additional state fees for a license. You have 365 days from the date of issuance of the LOQ to apply for licenses in other Compact states.
• During this process, you should monitor your email, including your spam/junk folders, for communications from both the IMLC Commission and NCMB, as well as from any other medical board in states where you apply for licensure. Failure to timely respond to any email communications may cause unnecessary delays.

On your application submitted through the IMLC Commission website you select the reasons that North Carolina is your state of principal license (SPL), which may include:
o The physician’s primary residence is in the Compact member state
o At least 25% of the physician’s practice of medicine occurs in the Compact member state
o The physician’s employer is located in the Compact member state
o The Compact member state is the physician’s state of residence for U.S. Federal income tax purposes

You must submit supporting documentation for all the reasons you have selected on the application provided through the IMLC Commission website. Examples of supporting documentation include:
o Primary residence: North Carolina issued identification card, such as driver’s license or identification card issued by the NC Division of Motor Vehicles; utility bill in your name for a residence located in North Carolina; or lease or mortgage documents for a residence located in North Carolina.
o 25% of practice occurring in North Carolina: a verification form completed and submitted by your employer; or attestation form along with a log listing the locations of all your patients within the past year.
o Employer located in North Carolina: a verification form completed and submitted by your employer
o For NC as state of residence for US federal tax purposes: a copy of your federal income tax return.

According to the IMLC, physicians must first be able to declare a State of Principal License (SPL) and always maintain their SPL status throughout their application process. In addition to designating an SPL, a physician must:

• Have graduated from an accredited medical school, or a school listed in the International Medical Education Directory or its equivalent such as the World Directory of Medical Schools
• Have successfully completed ACGME- or AOA-accredited graduate medical education
• Passed each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component (Please note that passing the Canadian Licentiate of the Medical Council of Canada, or the LMCC, DOES NOT meet this requirement)
• Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board
• Not have any history of disciplinary actions toward their medical license
• Not have any criminal history
• Not have any history of controlled substance actions toward their medical license
• Not currently be under investigation

At all times, you are obligated to follow the laws of the state in which you are practicing medicine, which is determined by the patient’s location at the time of care.

In addition to your eligibility for licensure and your supporting credentials, any investigative, litigation or compliance materials, including complaints may be shared between Compact member states.

Disciplinary actions taken by any Compact member state may affect the your licenses in other states. If North Carolina is designated as your SPL and your license is suspended, revoked, or any other similar status, all other licenses you hold within the Compact will automatically be placed on the same or similar status. Other disciplinary actions may trigger investigations or similar reciprocal actions.

The IMLC licensure pathway was implement in in North Carolina in January 2026.

No. The IMLC does not automatically grant you authority to practice in other states. The IMLC is an expedited pathway to licensure in all participating Compact member states. You are still required to apply for a license in North Carolina before you seeing patient located in North Carolina at the time of care, which you may do if you are eligible by applying through the IMLC Commission website.

Generally, a license is required in the state where the patient is located at the time of care.

You may still be able to apply for a license through a traditional pathway available on NCMB’s website. Before you begin the traditional application process, you should review the application checklist to ensure you qualify.

No. You must apply for reactivation or reinstatement through the NCMB website. Reactivation is available if your NC license lapsed within the last year, unless your inactivation occurred while under investigation or as the result of a disciplinary action. Reinstatement is available if your NC medical lapsed more than a year ago or you inactivated due to an investigation or disciplinary action. These applications are available on NCMB’s website.

• In order to apply for a NC medical license through the IMLC, you must first visit the IMLC Commission website and obtain a Letter of Qualification (LOQ) from your state of principal licensure. Your LOQ must have been issued within the past 365 days in order to apply for a NC license.
• Once you receive your LOQ from your SPL, you must visit the IMLC Commission website and submit your application for licensure by selecting North Carolina and pay the non-refundable $400 fee. The IMLC will transfer your application to the NC Medical Board for review.
• Once your license is issued, you need to submit supplemental information to the Board within 30 days. This supplemental information is required under North Carolina law and failure to submit the required information may result in an investigation and possible disciplinary action. Under the Compact, investigative and disciplinary information may be shared with other Compact member states where you hold a license.
• You should monitor your email, including any spam/junk folders, for any communications from the IMLC Commission, your state of principal license, or the North Carolina Medical Board. Failure to timely respond to any communications may cause unnecessary delays.

A physician’s SPL is the Compact member state where a physician holds a full and unrestricted medical license and meets one of the following criteria:

• The physician’s primary residence is in the Compact member state
• At least 25% of the physician’s practice of medicine occurs in the Compact member state
• The physician’s employer is located in the Compact member state
• The Compact member state is the physician’s state of residence for U.S. Federal Income Tax purposes

A Letter of Qualification (LOQ) is issued by the state in which you currently hold a medical license and states that you are eligible to apply for licensure with any Compact member state. Physicians wishing to obtain a license in North Carolina will need an LOQ from their state of principal license (SPL). An LOQ is only valid for 365 days from the date of issuance.

A Letter of Qualification (LOQ) issued by the physician’s state of principal license is valid for 365 days from the date of issuance.

According to the IMLC, physicians must first be able to declare a State of Principal License (SPL) and always maintain their SPL status throughout their application process. In addition to designating an SPL, a physician must:

• Have graduated from an accredited medical school, or a school listed in the International Medical Education Directory or its equivalent such as the World Directory of Medical Schools
• Have successfully completed ACGME- or AOA-accredited graduate medical education
• Passed each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component (Please note that passing the Canadian Licentiate of the Medical Council of Canada, or the LMCC, DOES NOT meet this requirement)
• Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board
• Not have any history of disciplinary actions toward their medical license
• Not have any criminal history
• Not have any history of controlled substance actions toward their medical license
• Not currently be under investigation

All North Carolina licenses are issued by North Carolina. The IMLC Commission does not issue a nationally recognized medical license for physicians.

At all times, you are obligated to follow the laws of the state in which you are practicing medicine, which is determined by the patient’s location at the time of care. This means when your patient is located in North Carolina, you are obligated to follow all North Carolina laws when practicing medicine in North Carolina. Please visit NCMB’s website for Professional Resources, Laws, Rules, and Position Statements.

In addition to your eligibility for licensure and your supporting credentials, any investigative, litigation or compliance materials, including complaints may be shared between Compact member states.

Disciplinary actions taken by any Compact member state may affect your licenses in other states. If your license with your designated SPL is suspended, revoked, or any other similar status, all other licenses you hold within the Compact, including your North Carolina license, will automatically be placed on the same or similar status. Other disciplinary actions may trigger investigations or similar reciprocal actions.

• You continue to renew your NC medical license annually on your birthday through the NCMB website as you have always done. You only use the IMLC Commission website to renew any licenses you have obtained through the Compact.
• If you fail to renew your NC medical license within 30 days of your birthday, your NC medical license will be inactivated. Unless you have designated another Compact state as your SPL, all your other Compact licenses will be inactivated as well.

• You will renew your NC medical license through the IMLC Commission website annually on your birthday. You will be required to submit an additional renewal application as well through the NCMB website. If you do not submit both applications within 30 days of your birthday, your license will be inactivated.
• As required by the Compact, you will receive a 90 day notice regarding your renewal. These emails may be delivered to your spam/junk folder and you should monitor your email accordingly.