Healthcare Provider Details

I. General information

NPI: 1093603284
Provider Name (Legal Business Name): DANA ELASMAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-5185
  • Fax: 704-446-5185
Mailing address:
  • Phone: 704-446-5185
  • Fax: 704-446-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-15757
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: