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General NPI Number Information
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NPI Number | 1639195126
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CARE OF CHARLOTTE, PA
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 15830 BALLANTYNE MEDICAL PL STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28277-0762
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Country | US
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Telephone | 704-341-0090
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Fax | 704-341-0092
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Provider Business Mailing Address
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Address Line | 15830 BALLANTYNE MEDICAL PL STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28277-0762
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Country | US
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Telephone | 704-341-0090
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Fax | 704-341-0092
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JAMES L. SEWARD
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Credential | MD
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Telephone | 704-821-0615
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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 | 9800340
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License Number State | NC
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