Healthcare Provider Details

I. General information

NPI: 1184848525
Provider Name (Legal Business Name): ERIC BARUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 PROVIDENCE RD STE 200
CHARLOTTE NC
28207-1235
US

IV. Provider business mailing address

3735 GLENLAKE DR STE 250
CHARLOTTE NC
28208-6866
US

V. Phone/Fax

Practice location:
  • Phone: 47-495-8007
  • Fax: 704-626-3272
Mailing address:
  • Phone: 704-749-5800
  • Fax: 704-626-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number88619
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2021-00874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: