Healthcare Provider Details

I. General information

NPI: 1750495511
Provider Name (Legal Business Name): DANA MEREDITH DORENFELD P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 BAUCOM RD SUITE 100
CHARLOTTE NC
28269-6762
US

IV. Provider business mailing address

3006 BAUCOM RD SUITE 100
CHARLOTTE NC
28269-6762
US

V. Phone/Fax

Practice location:
  • Phone: 704-596-1787
  • Fax: 704-596-6230
Mailing address:
  • Phone: 704-596-1787
  • Fax: 704-596-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: