Healthcare Provider Details

I. General information

NPI: 1265768485
Provider Name (Legal Business Name): GEORGE DIMITRI MAGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 19TH ST SE
HICKORY NC
28602-4230
US

IV. Provider business mailing address

1072 X RAY DR
GASTONIA NC
28054-7498
US

V. Phone/Fax

Practice location:
  • Phone: 828-325-9849
  • Fax: 828-325-9879
Mailing address:
  • Phone: 704-671-1094
  • Fax: 704-671-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number201501439
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: