Healthcare Provider Details

I. General information

NPI: 1376308718
Provider Name (Legal Business Name): ROWAN DIAGNOSTIC CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 04/10/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 BRENNER AVE STE 202
SALISBURY NC
28144-2567
US

IV. Provider business mailing address

611 MOCKSVILLE AVE
SALISBURY NC
28144-2705
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-7220
  • Fax:
Mailing address:
  • Phone: 704-633-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN STARRETT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 704-216-7064