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General NPI Number Information
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NPI Number | 1396705042
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Entity Type | Organization
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Legal Business Name | SOUTH CHARLOTTE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 03/26/2006
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Last Update Date | 03/20/2011
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Provider Practice Location Address
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Address Line | 10410 PARK RD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28210-8474
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Country | US
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Telephone | 704-540-6860
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 LOOKOUT CIR
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City | WAXHAW
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State | NC
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Zip | 28173-8085
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Country | US
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Telephone | 704-540-6860
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEETA KUKREJA
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Credential | M.D.
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Telephone | 704-540-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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