Healthcare Provider Details

I. General information

NPI: 1710940887
Provider Name (Legal Business Name): DERMATOLOGY CENTER OF SHELBY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WYKE ROAD
SHELBY NC
28150-3552
US

IV. Provider business mailing address

935 WYKE ROAD
SHELBY NC
28150-3552
US

V. Phone/Fax

Practice location:
  • Phone: 704-481-1142
  • Fax: 704-481-8305
Mailing address:
  • Phone: 704-481-1142
  • Fax: 704-481-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number009901064
License Number StateNC

VIII. Authorized Official

Name: DR. JOSEPH J URASH
Title or Position: PHYSICIAN
Credential: DO
Phone: 704-481-1142