Healthcare Provider Details

I. General information

NPI: 1386576205
Provider Name (Legal Business Name): MY PEDIATRIC DOCTOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ARROWRIDGE BLVD STE 1A-9
CHARLOTTE NC
28273-5755
US

IV. Provider business mailing address

8350 ARROWRIDGE BLVD STE 1A-9
CHARLOTTE NC
28273-5755
US

V. Phone/Fax

Practice location:
  • Phone: 678-448-6776
  • Fax:
Mailing address:
  • Phone: 678-448-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC DOHERTY
Title or Position: CEO
Credential:
Phone: 678-448-6776