Healthcare Provider Details

I. General information

NPI: 1245208628
Provider Name (Legal Business Name): SUSAN C ECHTERLING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 PINEVILLE MATTHEWS RD SUITE 102
CHARLOTTE NC
28226-8371
US

IV. Provider business mailing address

7108 PINEVILLE MATTHEWS RD SUITE 102
CHARLOTTE NC
28226-8371
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-2191
  • Fax: 704-542-4243
Mailing address:
  • Phone: 704-542-2191
  • Fax: 704-542-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200001027869
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9600903
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: