Healthcare Provider Details

I. General information

NPI: 1912894395
Provider Name (Legal Business Name): PLOHAL DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 HICKORYWOOD HILL AVE STE 200
HUNTERSVILLE NC
28078-3417
US

IV. Provider business mailing address

10210 HICKORYWOOD HILL AVE STE 200
HUNTERSVILLE NC
28078-3417
US

V. Phone/Fax

Practice location:
  • Phone: 704-931-3376
  • Fax: 704-601-7808
Mailing address:
  • Phone: 704-931-3376
  • Fax: 704-601-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA PLOHAL
Title or Position: AUTHORIZED OFFICIAL
Credential: NP
Phone: 704-931-3376