=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598297806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROWAN DIAGNOSTIC CLINIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2017
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 BRENNER AVE STE 102
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-216-7071
-----------------------------------------------------
Fax | 704-647-0515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 MOCKSVILLE AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-633-7220
-----------------------------------------------------
Fax | 704-647-0515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. PAUL VERHAEGHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-633-7220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------