Healthcare Provider Details

I. General information

NPI: 1457914020
Provider Name (Legal Business Name): DYLAN JAMES SKINNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 300
CHARLOTTE NC
28207-1112
US

IV. Provider business mailing address

PO BOX 604350
CHARLOTTE NC
28260-4350
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-0741
  • Fax: 704-333-3356
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2024-00806
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2024-00806
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: