Healthcare Provider Details

I. General information

NPI: 1386633188
Provider Name (Legal Business Name): FRANK E LORCH IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 RANDOLPH ROAD SUITE 105
CHARLOTTE NC
28211-1365
US

IV. Provider business mailing address

PO BOX 602148
CHARLOTTE NC
28260-2148
US

V. Phone/Fax

Practice location:
  • Phone: 704-863-4878
  • Fax: 704-896-0387
Mailing address:
  • Phone: 704-863-4878
  • Fax: 704-896-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200201121
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number200201121
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: