Healthcare Provider Details

I. General information

NPI: 1891804993
Provider Name (Legal Business Name): DIMITRIOS P HONDROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ELM LN STE 102
CHARLOTTE NC
28277-0716
US

IV. Provider business mailing address

PO BOX 4178
BELFAST ME
04915-4100
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-4000
  • Fax: 704-847-4001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200601131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: