Healthcare Provider Details

I. General information

NPI: 1427318294
Provider Name (Legal Business Name): ORTHOCAROLINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 BLAKENEY PROFESSIONAL DR SUITE 102
CHARLOTTE NC
28277-6718
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2000
  • Fax:
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number38865
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38865
License Number StateNC

VIII. Authorized Official

Name: BRENT SHEAR
Title or Position: CFO
Credential:
Phone: 704-323-2000