Healthcare Provider Details

I. General information

NPI: 1619400033
Provider Name (Legal Business Name): METROLINA DERMATOLOGY AND SKIN SURGERY SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 PARK RD
CHARLOTTE NC
28210-8479
US

IV. Provider business mailing address

9987 CARVER RD STE 250
BLUE ASH OH
45242-5553
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-7536
  • Fax:
Mailing address:
  • Phone: 937-433-7536
  • Fax: 937-433-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENE BRENT KIRKLAND
Title or Position: CMO
Credential: MD
Phone: 937-312-3820