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General NPI Number Information
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NPI Number | 1376917633
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Entity Type | Organization
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Legal Business Name | DILWORTH FACIAL PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1819 LYNDHURST AVE
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City | CHARLOTTE
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State | NC
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Zip | 28203-5103
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Country | US
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Telephone | 980-949-6544
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Fax | 980-422-0091
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Provider Business Mailing Address
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Address Line | 1819 LYNDHURST AVE
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City | CHARLOTTE
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State | NC
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Zip | 28203-5103
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Country | US
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Telephone | 980-949-6544
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Fax | 980-422-0091
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Authorized Official
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Title or Position | CO-OWNER
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Name | JOSHUA B SUROWITZ
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Credential | M.D.
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Telephone | 919-619-0383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2013-00940
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 2013-00940
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 2013-00940
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 2013-00940
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License Number State | NC
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