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General NPI Number Information
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NPI Number | 1215209820
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Entity Type | Organization
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Legal Business Name | ROWAN DIAGNOSTIC CLINIC
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 1035 DALE EARNHARDT BLVD
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City | KANNAPOLIS
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State | NC
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Zip | 28083-4477
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Country | US
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Telephone | 704-633-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 611 MOCKSVILLE AVE
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City | SALISBURY
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State | NC
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Zip | 28144-2705
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Country | US
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Telephone | 704-633-7220
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL A VERHAEGHE
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Credential |
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Telephone | 704-633-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 39379
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License Number State | NC
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