Healthcare Provider Details

I. General information

NPI: 1275236846
Provider Name (Legal Business Name): SAMUEL JOSEPH KERANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5871
US

IV. Provider business mailing address

600 HOSPITAL DR
MONROE NC
28112-6000
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-3181
  • Fax: 704-355-7047
Mailing address:
  • Phone: 980-993-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number316353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: