Healthcare Provider Details

I. General information

NPI: 1326231481
Provider Name (Legal Business Name): DHARMESHKUMAR THAKORDAS SURATWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 07/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 CAMERON VALLEY PKWY STE 300
CHARLOTTE NC
28211-4297
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-6255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2018-01142
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number2018-01142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: