Healthcare Provider Details

I. General information

NPI: 1518540533
Provider Name (Legal Business Name): RYAN SERBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SCOTT AVE
CHARLOTTE NC
28203-5844
US

IV. Provider business mailing address

4122 POLLUCK WAY
CHARLOTTE NC
28209-4992
US

V. Phone/Fax

Practice location:
  • Phone: 704-304-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: