Healthcare Provider Details

I. General information

NPI: 1417404344
Provider Name (Legal Business Name): CHARLOTTE FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 LYNDHURST AVE
CHARLOTTE NC
28203-5103
US

IV. Provider business mailing address

1819 LYNDHURST AVE
CHARLOTTE NC
28203-5103
US

V. Phone/Fax

Practice location:
  • Phone: 910-431-1644
  • Fax:
Mailing address:
  • Phone: 910-431-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSH SUROWITZ
Title or Position: M.D./OWNER
Credential:
Phone: 910-431-1644