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General NPI Number Information
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NPI Number | 1952736142
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Entity Type | Organization
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Legal Business Name | BRANDON GYNECOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 10310 MALLARD CREEK RD STE 101D MALLARD CROSSING MEDICAL PARK
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City | CHARLOTTE
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State | NC
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Zip | 28262-4563
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Country | US
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Telephone | 704-654-6765
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Fax |
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Provider Business Mailing Address
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Address Line | 4409 RANCLIFFE CT
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City | CHARLOTTE
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State | NC
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Zip | 28269-8403
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Country | US
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Telephone | 704-654-6765
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ROCHELLE M BRANDON
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Credential | M.D.
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Telephone | 704-654-6765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 9601242
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License Number State | NC
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