Healthcare Provider Details

I. General information

NPI: 1467402719
Provider Name (Legal Business Name): WILLIAM BEN HARLEY II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-7425
  • Fax: 704-316-9646
Mailing address:
  • Phone: 704-384-7680
  • Fax: 704-316-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number9400518
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: