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General NPI Number Information
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NPI Number | 1740434158
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Entity Type | Organization
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Legal Business Name | DARST DERMATOLOGY, PC
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 11301 GOLF LINKS DR N SUITE 203
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City | CHARLOTTE
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State | NC
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Zip | 28277-8013
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Country | US
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Telephone | 704-321-3376
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Fax | 704-541-6558
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Provider Business Mailing Address
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Address Line | PO BOX 5304
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City | JOHNSON CITY
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State | TN
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Zip | 37602-5304
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Country | US
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Telephone | 704-321-3376
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Fax | 704-541-6558
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC DARST
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Credential | MD
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Telephone | 704-321-3376
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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 | 2008-00083
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License Number State | NC
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