Healthcare Provider Details

I. General information

NPI: 1275292609
Provider Name (Legal Business Name): CONNOR VINCENT SKOWRONEK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 PARK RD STE 220
CHARLOTTE NC
28210-8542
US

IV. Provider business mailing address

8020 HARRINGTON WOODS RD
CHARLOTTE NC
28269-0787
US

V. Phone/Fax

Practice location:
  • Phone: 248-505-7869
  • Fax:
Mailing address:
  • Phone: 248-505-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: