Healthcare Provider Details

I. General information

NPI: 1326890013
Provider Name (Legal Business Name): NOAH VROMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 W HIGHWAY 74
MONROE NC
28110-8434
US

IV. Provider business mailing address

3615 TRYCLAN DR # 308
CHARLOTTE NC
28217-1329
US

V. Phone/Fax

Practice location:
  • Phone: 704-220-6054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: