Healthcare Provider Details

I. General information

NPI: 1013404532
Provider Name (Legal Business Name): LUKAS DAVID DUMBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-8493
  • Fax: 704-838-8494
Mailing address:
  • Phone: 704-838-8493
  • Fax: 704-838-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD474217
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2024-01326
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: