Healthcare Provider Details

I. General information

NPI: 1992720932
Provider Name (Legal Business Name): CHILDREN'S UROLOGY OF THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BALDWIN AVE
CHARLOTTE NC
28204-3110
US

IV. Provider business mailing address

230 BALDWIN AVE
CHARLOTTE NC
28204-3110
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-5636
  • Fax: 704-376-5636
Mailing address:
  • Phone: 704-376-5636
  • Fax: 704-376-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38823
License Number StateNC

VIII. Authorized Official

Name: MEREDITH G RAMIREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-376-5636