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General NPI Number Information
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NPI Number | 1184754848
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN DERMATOLOGY, PA
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 140 LEANING OAK DRIVE STE 101
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City | MOORESVILLE
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State | NC
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Zip | 28117-6991
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Country | US
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Telephone | 704-658-9730
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Fax | 704-658-1457
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Provider Business Mailing Address
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Address Line | 140 LEANING OAK DRIVE STE 101
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City | MOORESVILLE
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State | NC
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Zip | 28117-6991
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Country | US
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Telephone | 704-658-9730
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Fax | 704-658-1457
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL H SUGARMAN
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Credential | MD
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Telephone | 704-658-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 200500264
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 200500264
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License Number State | NC
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