Healthcare Provider Details

I. General information

NPI: 1013210517
Provider Name (Legal Business Name): KENT SEITZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 ORCHARD LAKE DRIVE SUITE C
CHARLOTTE NC
28270-9998
US

IV. Provider business mailing address

1421 ORCHARD LAKE DRIVE SUITE C
CHARLOTTE NC
28270-9998
US

V. Phone/Fax

Practice location:
  • Phone: 704-844-0181
  • Fax: 904-701-6279
Mailing address:
  • Phone: 704-844-0181
  • Fax: 904-701-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT SEITZ
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 704-844-0181